A QUASI EXPERIMENTAL STUDY TO ASSESS THE...
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A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON THE PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN AMONG THE PREMATURE
NEWBORNS IN SELECTED HOSPITAL, ERODE
BY
301417101
A DISSERTATION SUBMITTED TO THE TAMILNADU
Dr.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL
FULFILMENT OF THE REQUIREMENT FOR THE AWARD
OF THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER – 2016
A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON THE PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN AMONG THE PREMATURE
NEWBORNS IN SELECTED HOSPITAL, ERODE
BY
301417101
A DISSERTATION SUBMITTED TO THE TAMILNADU
Dr.M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL
FULFILMENT OF THE REQUIREMENT FOR THE AWARD
OF THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER – 2016
A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON THE PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN AMONG THE PREMATURE
NEWBORNS IN SELECTED HOSPITAL,ERODE
BY
301417101
Research Guide & :
Clinical speciality guide ------------------------------------------------
Prof. Mrs.M.KAVIMANI, R.N, R.M, M.S.N.,Ph.D
PRINCIPAL, HOD. PEDIATRICS,
SPMIHS,
PALAYAKOTTAI,
TIRUPUR DIST.
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR
THE AWARD OF THE DEGREE OF MASTER OF SCIENCE IN
NURSING FROM THE TAMILNADU Dr.M.G.R. MEDICAL
UNIVERSITY, CHENNAI.
OCTOBER – 2016
DECLARATION
This is to certify that the dissertation entitled “A QUASI EXPERIMENTAL
STUDY TO ASSESS THE EFFECTIVENESS OF MUSIC THERAPY ON THE
PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN
AMONG THE PREMATURE NEWBORNS IN SELECTED HOSPITAL, ERODE ” is
a bonafide work done by Ms.F.ABIMATHY, Shivparvathi Mandradiar Institute of
Health Sciences, College of Nursing in partial fulfillment of the university rules
and regulations for award of Master of Science in Nursing under the guidance and
supervision of during the year of October 2016.
Signature of the Principal &
Head of the department: ------------------------------------------------
Prof. Mrs.M.KAVIMANI, R.N, R.M, M.S.N.,Ph.D
PRINCIPAL, HOD. PEDIATRICS,
SPMIHS,
PALAYAKOTTAI,
THIRUPUR DIST.
DECLARATION
I hereby declare that the present dissertation titled “A quasi experimental study
to assess the effectiveness of music therapy on the physiological parameters, feeding
and sleeping pattern among the premature newborns in selected hospital, Erode”,
outcome of the original research work undertaken and carried out by me, under the
guidance of Research & Clinical Specialty Guide Prof. Mrs M. KAVIMANI, R.N, R.M,
M.S.N.,Ph.D Principal, Shivparvathi Mandradiar Institute of Health Sciences, College
of Nursing.
I also declare that the material of this has not found in any way, the basis for the
award of any degree/ diploma in this University or any other University.
BY
301417101
CERTIFIED THAT THIS IS THE BONAFIDE WORK OF
301417101
AT THE SHIVPARVATHI MANDRADIAR INSTITUTE OF HEALTH
SCIENCES, COLLEGE OF NURSING SUBMITTED IN PARTIAL
FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE
DEGREE OF MASTER OF NURSING FROM THE TAMILNADU
Dr.M.G.R. MEDICAL UNIVERSITY, CHENNAI.
Examiners:
1. _________________________
2. __________________________
----------------------------------------------------------------
Prof. Mrs. M. KAVIMANI, R.N, R.M, M.S.N, Ph.D
PRINCIPAL, HOD. PEDIATRICS,
SPMIHS,
PALAYAKOTTAI,
THIRUPUR DIST.
ACKNOWLEDGEMENT
Glory be to the name of the LORD and my Saviour, Who is the source
of my strength, inspiration and who blessed in every walk of my life and the
functional knowledge and wisdom.
I raise my heart in profound love and gratitude to the LORD
ALMIGHTY; He has been my shepherd and guiding force behind all my efforts.
His presence has been my anchor through the hard time.
With immense pleasure and gratitude, I the investigator of this study own
my heartfelt gratitude to all those who have contributed to the successful
completion of this dissertation.
I would like to express my sincere thanks to our Honourable Chairman,
Late Mr. Shivakumar Mandradiar for all his blessing. And also it is my
privilege to express my special thanks to Mr.Naveen Mandradiar, Secretary, Mrs.
Mano Mandradiar Correspondent, Mrs. Pallavi Mandradiar, Trustee, and Mr.
Balasubramaniam, Manager, SPMIHS College of Nursing, Palayakottai, for their
constant encouragement and support to complete this study.
Quality always makes difference through generosity, richness, kindness,
and intelligence. These quality aspects has been incorporated and accomplished in
this study through the effective, enriched, constant guidance and support from
respected Prof.Mrs.Kavimani, Principal, SPMIHS College of Nursing, Palayakottai.
The investigator feels that words would not be sufficient to express her attitude
towards her for having not spared herself; being patiently available always, the
timely correction, suggestions and ideas which have contributed to the
concretization of this research. I express my immense thankfulness to her for the
valuable guidance and making this effort a success.
I am deeply indebted to Ms. Dhanya R M.Sc (N), Assisstant Professor,
SPMIHS, for her guidance and constant supervision as well as for providing
necessary information regarding the project and also for her support in completing
the project.
I am indeed thankful to Prof. Dr. Dhanapal, Bio-statistician, SPMIHS,
Palayakottai, for his guidance in carrying out the necessary statistical analysis and
presentation of the data in the study.
I owe my profound gratitude and exclusive thanks to the panel of
experts namely Dr. Arvind kumar M.B.B.S, M.D , Dr. Vasanth kumar M.D and
Mrs. Pamila Sam M.Sc (N), Ms. Dhanya R M.Sc (N) and Ms. Suganthi, M.Sc (N)
for validating the tool admist of their busy schedule and providing valuable
suggestions
I extend my grateful thanks to Mr. M.K. Balamurali, musician for his
guidance and suggestion in selecting the music.
Heartfelt thanks to all the teaching staff and non teaching staff of
SPMIHS, for their contribution during my course of study.
A memorable note of gratitude to Ms. Vanitha, librarian, SPMIHS for the
patience and timely help, kind co-opeartion and attention for completing the
project work successfully.
I would like to thank the office staffs Ms. Saranya and Ms. Akila
maheswari for their contribution during my course of study.
I express my special gratitude and thanks to Dr. Sulochana
Karupannan MS., Mch.,FICS., Chairman of Care 24 Medical Center and Hospital,
Erode, for permitting me to conduct the study and I am very grateful to all the
series for their kind co-operation during the study period.
I extend my warm and heartfelt thanks to all the participants, who have
willingly share their precious time during the process of interview. Without their
kind co-operation it is impossible for me to go ahead with this study.
I express my profound thanks to all my friends and brothers for
supporting me in many ways during the study and I thank all the well wishers
for their love and support in every step of the project.
Words are beyond expression for the meticulous, I express my love and
gratitude to my beloved parents Mr. N. Francis Eby (late), Mrs. D. Flora, and my
sister Ms. F. Madhu Francis, walk with me in all life ways and inspiration,
continous support, unending love, special prayers, constant encouragement and
strength which made my study, a dream come true.
I am using this opportunity to express my gratitude to everyone who
supported me throughout the course of this project. I am thankful for their aspiring
guidance, invaluably constructive criticism and friendly advice during the project
work. I sincerely thank them for sharing their truthful and illuminating views on a
number of issues related to the project.
301417101.
TABLE OF CONTENTS
CHAPTER NO
CONTENTS
PAGE NO
1. INTRODUCTION Background of the study
Need for the study
Statement of the Problem
Objectives of the study
Hypothesis
Operational definitions
Assumptions
Delimitations
Conceptual Frame work
1
6
9
10
10
11
12
12
12
2. REVIEW OF LITERATURE Studies related to Premature newborns Studies related to Music therapy in premature newborns Studies related to Music therapy and physiological parameters, feeding and sleeping patterns in premature newborns
18
23
27
3. METHODOLOGY Research approach
Research design
Variables
31
32
34
Settings
Population
Sample and sample size
Sampling Technique
Sampling Criteria
Development of the tool
Description of the tool
Validity
Reliability
Pilot study
Data collection procedure
Plan for data analysis
Ethical consideration
36
36
37
37
37
38
38
40
41
41
42
44
45
4. DATA ANALYSIS AND INTERPRETATION Data on selected Demographic variables of the
Premature Newborns in the experimental and control
group
Data on comparison of Physiological parameter,
Feeding and Sleeping pattern among Premature
Newborn among experimental and control group
Data on the Effectiveness of Music therapy on the
Physiological parameters, Feeding and Sleeping pattern
among the Premature Newborns
48
54
61
Data on the association of Post test level of
Physiological parameters, Feeding and Sleeping pattern
and their selected demographic variables among
experimental group
64
5. SUMMARY, FINDINGS, DISCUSSION, IMPLICATIONS, RECOMMENDATIONS AND CONCLUSION Summary
Findings
Discussion
Implications
Limitations
Recommendations
Conclusion
70
73
77
82
84
84
85
REFERENCES Text books
Journals
Electronic sources
APPENDICES
86
87
91
92 - 121
LIST OF TABLES
TABLE NO
TITLE
PAGE NO
1.
Frequency and percentage distribution of selected
demographic variables of the experimental and control
group.
48
2.
Mean, SD of the post test level of physiological
parameters of the experimental and control group.
54
3.
Mean, SD, mean difference and unpaired t value of post
test level of feeding pattern among the experimental and
control group.
57
4.
Mean, SD, mean difference and unpaired t value of post
test level of sleeping pattern among the experimental
and control group.
59
5.
Mean, SD of the physiological parameters of the
experimental group.
61
6.
Mean, SD, mean difference and t value of pre test and
post test level of feeding pattern of the experimental
group.
62
7.
Mean, SD, mean difference of pre and post test level of
sleeping pattern of the experimental group.
63
8.
Association between the post test level of feeding
pattern of the experimental group and their selected
demographic variables.
64
9.
Association between the post test level of sleeping
pattern of the experimental group and their selected
demographic variables.
67
LIST OF FIGURES
FIGURE
NO
TITLE
PAGE
NO
1.
Conceptual framework.
16
2.
Research design.
33
3.
Frequency and percentage distribution of pre test and
post test level of feeding pattern in experimental and
control group.
56
4.
Frequency and percentage distribution of pre test and
post test level of sleeping pattern in experimental and
control group.
58
5.
Overall frequency and percentage distribution of pre test
and post test level of physiological parameters, feeding
and sleeping pattern in the experimental and control
group.
60
LIST OF APPENDICES
NO
CONTENT
PAGE NO
1.
Letter seeking permission to conduct study
92
2.
Letter granting permission
93
3.
Letter requesting for content validity
94
4.
Content validity certificate
96
5.
List of experts
97
6.
Informed consent requisition form
98
7.
Informed written consent form – English & Tamil
99
8.
Confirmation of music certificate
103
9.
Self structured interview guide
Demographic variables Preterm Infant Breastfeeding Behavior Scale Modified Brief Infant Sleep Questionnaire
- English and Tamil.
104
10.
Procedure on music therapy
121
LIST OF ABBREVATIONS
SHORT FORMS
ABBREVATIONS
SPMIHS H1 M.Sc(N) SD BISQ PIBBS HR RR SPO2 P WHO NICU
X2
Shivparvathi Mandradiar Institute of Health Sciences Research hypothesis Master of Science in Nursing Standard Deviation Brief Infant Sleep Questionnaire Preterm Infant Breastfeeding Behavior Scale Heart rate Respiratory rate Oxygen saturation Probability World Health Organization Neonatal Intensive Care Unit Chi square
ABSTRACT
A qausi experimental study to assess the effectiveness of music
therapy on the physiological parameters, feeding and sleeping pattern among the
premature newborns in NICU, in selected hospital at Erode was done by 301417101
as a partial fulfillment of the requirement of the degree of Master of Science in
Nursing at Shivparvathi Mandradiar Institute of Health Sciences, under the
Tamilnadu Dr. M.G.R. Medical University Chennai October – 2016.
The Objectives of the study were
1. To assess the pre and post test level of physiological parameters, feeding and
sleeping pattern among the experimental and control group.
2. To compare the pre and post test level of physiological parameters, feeding
and sleeping pattern among the experimental and control group.
3. To assess the effectiveness of music therapy on the pre and post test level of
physiological parameters, feeding and sleeping pattern among the
experimental group.
4. To find the association between the post test level of physiological
parameters, feeding and sleeping pattern and their selected demographic
variables among the experimental group.
The research hypothesis formulated and tested were
H1: There is a significant difference in the post test level of physiological
parameter, feeding and sleeping pattern between the experimental and control group.
H2: There is a significant association in the post test level of physiological
parameters, feeding and sleeping pattern of the premature newborns of the experimental
group and their selected demographic variables.
The conceptual framework for the present study is based on upon
Ernestine Wiedenbach’s Art of clinical nursing theory. The investigator organized
the review of literature as studies related to premature newborns, studies related to
Music therapy in premature newborns, studies related to Music therapy and physiological
parameters, feeding and sleeping pattern of premature newborns.
The research design used was a quasi experimental design. The data
collection tool was validated by two pediatricians and three nursing experts.
Reliability was established by inter–rater (0.64) and test-retest method (0.95). The
samples for the study were chosen using purposive sampling technique, 25 were in
experimental and 25 in control group. Data was collected by self structured
interview method by using Preterm Infant Breastfeeding Behavior Scale by Nyqvist
and a modified Brief Infant Sleep Questionnaire by Sadeh, to assess the physiological
parameters, feeding and sleeping pattern and Music therapy was given for 15
minutes for three consecutive days for 4 weeks.
The main study was conducted in NICU of Care 24 Medical Center and
Hospital, Erode. The data collected were edited, tabulated, analyzed and interpreted
by manually and validated by the Bio statistician. The paired test t value for
feeding pattern was 20 and for sleeping pattern was 12.28 at P<0.05 revealed that
there was a significant improvement in maintaining the physiological parameters,
improved feeding and sleeping pattern after the music therapy. It was inferred that
there was a significant difference in maintaining the physiological parameters,
improved feeding and sleeping pattern and they were good improvement in the
experimental group than the control group. There was no significant association
between the post test level of physiological parameters, feeding and sleeping
pattern of the premature newborns and their selected demographic variables.
The study concluded that the music therapy was effective in improving
the physiological parameters, feeding pattern and sleeping pattern among the
premature newborns, in the hospital setup. The implications, limitations,
recommendations and conclusion were clearly spelt.
1
CHAPTER - 1
INTRODUCTION
“A HEALTHY BABY IS A SURE FUTURE”
-WHO.
Background of the study:
Children constitute the most Important and vulnerable segment of our
population. They are truly the foundation of our nation. Hence the focus of every
citizen should be, to promote their health and safeguard their interests. So every
unborn child should be allowed to achieve his or her optimal growth and
development potential so that he can effectively contribute towards nation’s
productivity. The future of our nation depends on the way in which we nuture our
children today.
The birth of an infant is one of the most owe inspiring and emotional
event that can occur in one’s life time. After nine months of anticipation and
preparation the neonate arrives amid a flurry of excitement. The new human being
affects the life of the parents and also the other members of the family. If the
neonate is not the robust, healthy, lovable infant as expected, parents find it very
difficult to cope with these changes and feel varying degree of turmoil and anxiety.
Proper care of the newborn babies forms the foundation for the qualitative outcome
without any mental and physical disabilities.
2
Preterm infants are those born before 37 weeks of gestation. This replaces
the term prematurity. The physiological parameters are less obvious when compared
to adults. The immaturity places infants at risk for not only neonatal complications but
also for other higher-risk factors. . In the present era of science and technology,
where quality is the supreme priority, Quality of life can only be accredited by
decreased morbidity and mortality rate of newborn.
Sarah Harding (2015) states that depending on how early the delivery occurs
during the pregnancy, a premature baby can have different characteristics than a full-term
baby. Over time, the characteristics become less noticeable. Premature babies require
close monitoring and sometimes special medical assistance in NICU. Preterm babies will
have a number of distinct characteristics as various stages of development. Identification
of these characteristics provides valuable clues to the physiologic capabilities of the
infants.
The general, outward physical appearance changes on the fetus progresses to
maturity. Preterm babies are very small and appear scrawny because they have or lack
only minimal subcutaneous fat deposits and have proportionately large head in relation to
the body. Premature babies who arrive between weeks 30 and 32 are likely to have thin
skin as a result of limited body fat, explains the March of Dimes. The skin is often
wrinkly. Extremely premature infants, those who are delivered anytime between the 24th
and 27th weeks, have yet to develop the exterior layer of the skin.
In contrast to full term babies, overall attitude of flexion and continuous
activity, preterm infants are inactive and listless. The movements of a baby born between
29 and 32 weeks may appear jerky instead of smooth. Babies born before these weeks
3
may not move much at all. The extremities maintain an attitude of extension and remain
in any position, which they are glaced. Around the 35th week, a preterm baby has got
enough muscle tone to get into the fetal position, like a full-term.
The premature baby’s reflex activity is only partially developed. Sucking is
absent or weak due to the infant’s poor muscle tone. The cries of an early baby are often
weak. Other neurologic signs are absent or diminished. Physiological immature, preterm
babies are unable to maintain body temperature, have limited ability to excrete solutes in
the urine and have increased susceptibility to infection. A pliable thorax, immature lung
tissue and an immature regulatory center lead to periodic breathing, hypoventilation and
frequent periods of apnea.
Premature infants born between 34 and 37 weeks of pregnancy usually appear
healthy at birth but may have more difficulties adapting than full-term babies. These
preterm babies usually require more sleep and they may even sleep through a feeding,
which indicates they miss much-needed calories. Most infants require special feeding
methods and supplemental calories.
As a consequence of anatomic, physiologic, and biochemical inadequancies, the
premature infant is prone to a variety of problems that must be anticipated and managed.
Subsequent care is determined by the status of the infant. The care differs from that of the
full-term infant primarily in the areas of Respiratory support, Temperature regulation,
Nutrition, susceptibility to infection, Activity intolerance, and other consequences of
physical immaturity.
4
The popularity and credibility of alternate treatment modalities such as
music therapy also have increased over the past decade. Support for the use of
music with infants is not limited to music therapy literature; in fact; authors in
several other fields of study have written about the benefits of using music to
create a nurturing environment for infants.
Music is a non-pharmacological non-chemical method used as an adjunct
to traditional care and medical treatment. From a nursing perspective, music
interventions have been used to promote patient’s health and well-being. Music is a
source of pleasure for many people and has been used throughout history to
alleviate sickness and suffering. Florence Nightingale noticed the power of music
in the early 1800s. she thought that music with a continued harmony, performed
by the human voice, on wind instruments and on string instruments, had a
beneficial effect.
Listening to music is a complex phenomenon, involving psychological,
emotional, neurological, endocrinological and cardiovascular changes. The
physiological reaction to music is qualitatively similar in musicians and non-
musicians. An arousal effect proportional to the speed of the music is described in
the literature: with slower rhythms inducing relaxation greater than preceding the
exposure to music.
This evidence leads to the speculation that the music may give
pleasure, and perhaps health benefit, as a result of controlled alternation between
arousal and relaxation.
5
According to National association for Music Therapy, music
therapy(MT) consists of using music to achieve therapeutic objectives; restoration,
maintenance, and increase in health, both physical and mental. More specifically,
music has been shown to decrease pain, stress, anxiety and demand for analgesic
and anesthetic drugs.
Music seems to have measurable benefits on physiological and
psychological outcomes in pediatric age, although infant and children previously
exposed to music treatment protocols could be distracted from unpleasant
symptoms, calmed during stressful events such as invasive procedures, and less
distressed while hospitalized.
Standley (2003) used music therapy to aid in the treatment of certain
Medical conditions is fast becoming a recognized and widespread practice. The
utilization of music in medical treatment however is actually an ancient idea.
Historically music has often been associated with the treatment of disease.
Light et.al (1954) the oldest written example is the KAHUM PAPYRUS, a
document describing the use of incantations for healing. Quite monumentally this
study demonstrated the beneficial effects of music on specific physiological
process such as cardiac output, respiratory rate, pulse rate, blood pressure.
6
As a result of findings like these, clinical music therapy programs have
been developed for hospital units using research based interventions. Medical
Music therapy research and practice has expanded beyond adult hospital patients
to pediatric and NICU.
Music has been used as an intervention purported to facilitate
development in Young, at-risk children and infant stimulation and early
intervention programs. Over the past decades, music has been introduced into the
Neonatal Intensive Care Unit as a therapy designed to enhance treatment and
facilitate growth and development of premature infants.
Need for the study:
The hospital care of premature and low-birth infants requires
expensive technology and experienced care. More than ever before the
Neonatalogical care besides the medical and nursing work has to been balanced
between protecting the child against over extension due to the concept of
“Minimal handling” and on the other hand the necessary fostering of the young
patients psychic and sensomotoric development during the long stationary treatment.
WHO (Nov 2015) reports that 15 million babies are born preterm every year.
Preterm birth complications are the leading cause of death among children under 5 of
age, responsible for nearly 1 million deaths in 2013. Across 184 countries, the rate of
preterm birth ranges from 5% to 18% of babies born. Globally about 60% of preterm
7
births occur in Africa and South Asia. In the lower income countries, on an average of
12% born too early compared with 9% in higher income countries.
India contributes to 17.5% of world’s population and nearly one-fifth of the total
live births. India ranks 36th in the list of preterm births globally, which includes 199
countries. Of the 27 million babies born in India annually (2010 figure), 3.6 million are
born prematurely of which 303,600 babies don’t survive due to complications.
India accounts more than 40% of the global burden of low-birth weight babies
with 7.5 million babies being born with a birth weight less than 2500gms. Among these
40% are born preterm, constituting a quarter of the global burden of the preterm births.
Prematurity is the cause of 35% of the Neonatal death in India.
India has witnessed a significant reduction in the number of Neonatal deaths from
1.35 million in 1990 to around 0.76 million in 2012. The Neonatal Mortality rate is not
uniform across India. Kerala has attained single digit (7/1000 live births) in Neonatal
Mortality rate, while Uttar Pradesh, Madhya Pradesh, Bihar and Rajastan contribute to
56% of the total Neonatal deaths in India.
According to the vital statistic of Tamilnadu, the Birth rate for the year 2013
was found to be 15.6 and the Death rate was found to be 7.5/1000 live births. In
Tamilnadu, the Urban Neonatal Mortality Rate was found to be 11 and the Rural
Neonatal Mortality Rate was found to be 18 per 1000 live births.
8
Standley (2008),quoted that Music benefits documented for the full term
newborns may also apply to the premature infants, that is, lullabies promote
language development, familiar music is recognized, reinforcing and comforting and
infant orient to and avidly attend to music more than other auditory stimuli. This
burgeoning area of research provides exciting possibilities for the practice of
music therapy in NICU and for music education in early childhood.
Preterm babies are also having some sort of anxiety and stress even
though we are not taking care of. Several studies have shown how music therapy
enhances the efficacy of nursing interventions that is the majority of NICU staff
preferred live recorded music and music appears to be an acceptable intervention
in Neonatal intensive care unit.
Nordoff and Robbins(1997) states that music therapy is an important
intervention that is soothing for the infants. Music therapy can also encourage
parent involvement, support infant development and optimize preterm infant’s neuro
developmental outcomes.
Elena and Nick (2008) reported that music has an effect on the state of
pediatric patients, potentially improving the physiological well being of long term
hospitalized children when exposed to live music.
Zenter (1996) states that the highest mortality among infants is due to
prematurity. Prematurely born infant emerges into a hectic, cold, noisy and bright
environment filled with mysterious equipments and masked people who try to
9
help. Thus the experience in Neonatal Intensive Care Unit contains frequent
aversive procedures, excess handling and disturbance of rest, noxious oral
medications, noise, bright light. These conditions are sources of stress and anomalous
stimulation.
The holistic movements has become a challenge to health care
professionals and music is one of the few interventions that can be considered
truly holistic. Research and clinical findings support the uses of music in a variety
of physical and psychological conditions.
Therefore from the above findings the researcher felt that it is a need to
conduct the present study to assess the effectiveness of music therapy in preterm
neonates.
Whipple and Glynn (1992) stated that soothing music resulted in a
significant increase in the pain threshold of 10 healthy female volunteers. The length
of the hospitalization was shorter and average weight gain was greater for infants,
whose Parents received training in music.
Statement of problem:
A study to assess the effectiveness of music therapy in physiological
parameters, feeding and sleeping pattern among the premature newborns in NICU, at
selected hospitals, Erode
10
Objectives of the study:
To assess the pre and post test level of physiological parameters, feeding and
sleeping pattern among the experimental and control group.
To compare the pre and post test level of physiological parameters, feeding
and sleeping pattern among the experimental and control group.
To assess the effectiveness of music therapy on the pre and post test level of
physiological parameters, feeding and sleeping pattern among the
experimental group.
To find the association between the post test level of physiological
parameters, feeding and sleeping pattern and their selected demographic
variables among the experimental group.
Hypothesis of the study:
H1: There is a significant difference in the post test level of physiological parameter,
feeding and sleeping pattern between the experimental and control group.
H2: There is a significant association in the post test level of physiological
parameters, feeding and sleeping pattern of the premature newborns of the
experimental group and their selected demographic variables.
11
OPERATIONAL DEFINITION:
EFFECTIVENESS: In this study, effectiveness is the difference in physiological
parameters in the preterm newborns before and after music therapy.
MUSIC THERAPY: It is the systematic application of music to induce relaxation ,
improve physiological parameters, induce sleep , increase feeding for the premature
newborns.
PHYSIOLOGICAL PARAMETERS: In this study the physiological parameters
include heart rate, respiratory rate, and oxygen saturation.
PRETERM NEONATES: Preterm neonate are the babies born of less than 37
completed weeks. In this study, preterm babies means the babies born from 30 to 36
weeks.
FEEDING PATTERN: In this study, the pattern by which the baby takes the
breast feeding from the mother by sucking, latching and swallowing.
SLEEPING PATTERN: In this study, the pattern of sleep shown by the baby
which includes the waking and crying spells.
12
ASSUMPTIONS:
Music therapy is effective to improve the physiological parameters for the
premature newborns.
Music therapy improves the feeding and sleeping pattern for the premature
newborn.
Music therapy is more feasible to practice.
DELIMITATIONS:
The study is delimited to:
The population of the preterm neonate who were with a gestational age from 30 to
36 weeks.
Who was admitted in the hospital at the time of data collection.
Who was on breast feeding.
The study was limited to four weeks.
CONCEPTUAL FRAME WORK :
A conceptual frame work or model refers to a set of concept and assumption that
integrate them in to a meaningful configuration.
POLIT and HUNGLER (2004) states that conceptual frame work is interrelated
concepts or abstractions that are assembled together in some rational scheme be their
relevance to a common theme. A framework may serve as a spring board for scientific
advancement.
13
A conceptual frame work is made up of concepts, which are mental images of a
phenomenon. Those concepts are linked together to express the relationship between
them. It guides the researchers to know what data has to be collected and provides
direction to the whole research process.
Conceptual frame work for this study was developed on the basis of Ernestine
Wiedenbach’s Art of clinical nursing theory. Prescriptive theory directs action toward an
explicit goal. It consists of 3 factors- central purpose, prescription based on central
purpose and implements it according to the realities of the situation.
A. Central purpose in the model refers to what the nurse wants to accomplish. It is the
overall goal towards which a nurse strives: it transcends the immediate intent of
the assignments or task by specifically directing activities towards the patient god
B. Prescription refers to the plant of care for a patient. It specifies the nature of the
action that will fulfill the Nurse’s central purpose and the rationale for that action.
C. Realities refers to the physical, physiological, emotional and spiritual factors that
come into play in a situation involving action. The five realities identified by
Wiedenbach’s are agent, recipient, goal, means, frame work.
Central purpose:
The central purpose of the study is to improve the physiological parameters,
feeding and sleeping pattern among the premature newborns.
14
Prescription:
The researcher plans the prescription that will fulfill the central purpose (improve
the physiological parameters, feeding and sleeping pattern among premature newborns)
by identifying the various means to achieve the goal. Thus the researcher have selected
the method, music therapy , which is considered as a safe and effective to improve the
physiological parameter, feeding and sleeping pattern among premature newborns
without any serious side effects.
Realities :
1. Agent - Researcher or Investigator
2. Recipient - Premature new born
3. Goal - To improve the physiological parameters, feeding and
sleeping pattern.
4. Means - Music
5. Frame - selected hospitals in erode.
Identification :
This includes the identification of the needs to improve the physiological
parameters, feeding and sleeping pattern with the help of PIBBS and BISQ.
Ministration:
It refers to administering music to improve the physiological parameters ,
feeding and sleeping pattern.
15
Validation:
It refers to evaluation of the effectiveness of music therapy. A positive outcome
represents the improvement in the physiological parameters, feeding and sleeping pattern
among premature newborns after giving music therapy. The negative outcome represents
the decline or non-improvement in the physiological parameters, feeding and sleeping
pattern among the premature newborns.
Co-ordination:
Refers to reporting and conferring of administering music.
16
Figure -1 Conceptual framework.Ernestine Wiedenbach’s art of clinical nursing theory.
Identification Ministration Validation Co- ordination
Background variables:
Gestational weeks
Age Birth weight Birth order Cry at Birth APGAR score Gender Religion Residential
Area Educational
status of mother
Occupational status of
Experimental Group
Pretest :
self structured Questionnaire modified BISQ & PIBBS scale
Music therapy
Post test :
Self structured Questionnaire modified BISQ &
PIBBS scale
Improved physiological parameter, improved feeding & sleeping pattern
No change in physiological parameters, feeding & sleeping pattern
Reporting
Consulting
conferring
Control group
17
CHAPTER – 2
REVIEW OF LITERATURE
“A great literature is chiefly the product of inquiring minds in revolt against the
immovable certainties of nation”
- Mecken H.C
Review of literature is a systematic, identification, location, scrutinizing and
summary of written materials that contain information on research problem.
Review of literature is a key step in research process. Literature review can
either be a part of a larger report of a research project, a thesis or bibliographic essay that
is published separately in a scholarly journal.
The literature review is to discover what has previously been done about the
problem to be studied what remains to be done, what methods have been employed in
other research and how the result of other research in the area can be combined to
develop knowledge.
The review of literature in the present study is organized as follows
i. Studies related to premature newborns.
ii. Studies related to Music therapy in premature newborns.
iii. Studies related to Music therapy and physiological parameters, feeding and
sleeping pattern of premature newborns.
18
SECTION- I. STUDIES RELATED TO PREMATURE NEWBORNS
Saumya John (2015) has conducted a quasi experimental study to assess the
effectiveness of massage therapy on weight and sleep wake pattern among preterm
infants in Government Head Quarters Hospital, Kancheepuram. Through convenient
sampling technique, 60 samples were collected and grouped as experimental and
control. The massage therapy was given to the preterm infants in the experimental
group for 15 minutes for 5 days. The pretest and posttest scores of weight of
preterm infants of experimental group are respectively pretest M= 1880.33,
SD=234.29 and posttest M=2032.50, SD=26.39 which is statistically significant,
t=12.47, p=0.00. The pretest and posttest score of sleep wake pattern of preterm
infants of the experiment group were pretest M=2.10, SD=0.61 and posttest M=2.38,
SD=0.38 respectively which showed statistically significant difference, t=8.93,
p=0.00. Therefore it was concluded that the massage therapy is effective in
promoting weight gain and sleep wake patterns among preterm babies.
Jemima (2015 ) has conducted a quasi experimental study to assess the
effectiveness of prone position on oxygen saturation among preterm babies, who
are admitted in the Government Vellore Hospital, Adukampari, Vellore. Using non
probability convenient sampling method 60 preterm babies were selected, and they
were allotted for experimental and control group by lottery method. The babies in
the study group were made to lie on their stomach with their face turning
towards the side and the level of SPO2 was monitored for every 30 minute for
about 2 hours. The pretest and posttest level of oxygen was assessed. The study
result reveals that post test score of oxygen level in experimental group is
M=92.27, SD=1.74 and in control group is M=8.37, SD=1.19, which is statistically
significant p=0.05, t=2.08. Therefore it was concluded that the prone positioning
19
improves the oxygen saturation of the preterm babies with inadequate Oxygen
saturation.
Marie Ellis (2014) on behalf of WHO published in the journal PLoS medicine
regarding the prevalence of Asthma in preterm babies. The researchers studied data on
more than 1.5 million children around the world. The researchers used information in
patients born from 1990s , and about 30 studies from six different continents, while
majority of the studies came from Europe. The study revealed that the preterm babies are
50% more likely to develop Asthma. The research team also found out that the babies
born before 37 weeks were 50% more likely to develop Asthma and those born 2 months
early were 3 times as likely to develop asthma when compared to full term babies.
August and Edmonds (2014) conducted a descriptive cohort study to investigate
about the specific rates of neonatal skin breakdown from pressure including location,
stages and etiology associated with tissue damage, in North Queensland’s tertiary
perinatal centre over a 2 year period and about 247 neonatal patients were reviewed.
Prevalence audits for pressure injuries to the skin were conducted and incorporated
categorization of with degree of tissue breakdown between stage 1-4. The study result
revealed that 31.2% were identified as having a skin injury. In total 107 injuries were
identified with the mean number of 1.4 injuries. The mean gestational age was 28 weeks
(range 22 – 41 weeks, S.D 4.1 weeks) and the mean birth weight was 1155g (range 445-
2678g, S.D 620g). Factors identified as contributing to pressure injuries included
indwelling vascular catheters (22.4%), Non-invasive continous positive airway pressure
delivery devices (14.1%), oxygen saturation and temperature probes (17.8%). 31.8% of
injuries could not be associated with specific risk factors. So it was concluded that the
neonates are undeniably at risk for pressure injuries however, it is still unclear which
proportion of the injuries are entirely preventable.
20
Thilaga and Shantha (2014) has conducted a quasi experimental study to
determine the effect of tactile stimulation on selected parameters among preterm babies
admitted in NICU at Kasturibai Hospital, Gandhigram. The study sample consists of 60
babies. The tactile stimulation was given with the sesame oil massage all over the body
except the cranium and the eyes. The result was found that the preterm babies, who
received tactile stimulation achieved weight gain(t=12.5), stable heart rate(t=21.69),
increased sleeping time(t=11.63), and decreased crying spells(t=10.25) than control
group(p<0.05). The study concluded that the tactile stimulation, when administered to
preterm babies, has a beneficial effect on growth and behavioral development.
Helth and Jarden (2013) conducted a hermeneutic phenomenological qualitative
study to explore how the fathers of the premature infants experience and potentially
benefit from using skin-to-skin method during their infants admission in NICU. The
study was conducted in NICU, Copenhagen University Hospital, Denmark. In-depth
semi-structured interviews was done to the fathers of the premature infants. From the
result the researcher finally concluded three themes- “Competent parenthood, Paternal
roles and the division of roles between the parents, and Balance between working life
and the time spent with the infant”. It was revealed that the skin-to-skin enhances the
father’s ability to play a caring role in their infant’s life and it also helps them to
understand their own role as a father. Therefore the Health Professionals should focus on
promoting the abilities of both parents and on ascribing the fathers an equal and imported
role in their infant’s care.
Jasmine Rani (2013) has conducted a study to assess the effectiveness of
Nesting upon Bio-physiological parameters, Neuro-behavioral activity and sucking
responses among preterm babies in St.Antony’s Hospital, Chennai. Total of 60
samples were collected by simple random sampling technique and they are divided
21
into control and experimental group respectively. Data was collected through the
interview method by using Neonatal variable proforma and Obstetrical variable
proforma. The Bio-physiological parameters, Sucking and Neuro-behavioural activity
was assessed before Nesting for the experimental and control group. Nesting was
given for a period of 6 hrs consecutively for 2 days. The observations were made
at 1 hr, 3rd hr and 6th hr. The study revealed that there is improvement in the body
temperature of the preterm babies in experimental group, M=98.28, SD=0.26, when
compared to control group M=97.15, SD=0.15. It was also inferred that the Sucking
response of the preterm newborn babies after Nesting was high, M=12.35, SD=2.15
in comparison with the pretest M= 9.88, SD=2.36 and the difference was
significant at p<0.05 level. It was concluded that Nesting can also reduce the
alterations in thermoregulations in the early Neonatal period. Thus Nesting
enhances the sleep, sucking response and there is improvement in weight gain of
the preterm babies.
Marlow (2007) conducted a comparative study about the survival rates of the
premature infants in the University college London’s Institute for Women’s Health. He
mentions that the survival rate after being born prematurely is rising. The overall survival
rate among the babies born is 40% in the year 1995 and now which is raised up to 53% in
the year 2006. The number of premature newborn admitted to NICU also rose from 666
in 1995 to 1115 in 2006 which reflect the advances in the neonatal medicine. Although
the proportion of experiencing severe disability has not been changed which is found to
be 18% in 1995 and 19% in 2006. The study concluded that the increased chance of the
survival rate is due to the administration of steroids to the mothers who are thought
likely to imminently give birth to an extremely premature baby, which boots the child’s
lungs before birth.
22
Bottos (1984) conducted an experimental study on the effects of a containing
position in a hammock versus the supine position on the cutaneous oxygen level in
preterm babies, in the NICU of the University of Padova, Italy. The study included 40
babies whose gestational age is less than 38 weeks. Among the premature babies, 11 were
with hyaline membrane disease, 8 with perinatal asphyxia and 6 were small for
gestational age. A little hammock was placed inside the incubator and then the baby is
placed over it. The hammock helps the baby to maintain the position of correctly
contained, which is similar to inutero. The study result showed that the hammock inhibits
or shortens the dystonic phase and it also facilitates bringing in the hands of the
premature babies to the middle pattern which is one of the basic milestone neuro motor
development. The usage of hammock helps in maintaining the baby’s head in midline
which stimulates the visual exploration of the environment and also the risk of milk
aspiration is greatly reduced.
23
SECTION - II. STUDIES RELATED TO MUSIC THERAPY IN PRETERM
NEWBORNS:
Schlez A (2011) Israel, has conducted a study regarding combining live harp
music therapy and kangaroo Mother care on short-term physiological and behavioral
parameters of preterm infants and their mothers in NICU setting. 52 infants born between
32 and 37 weeks of gestation were included. The infants were given kangaroo care and
live music therapy or kangaroo care alone. Neonatal heart rate, oxygen saturation,
respiratory rate along with neonatal behavior state and the maternal anxiety state were
also recorded. The result showed that, compared with kangaroo care alone, kangaroo care
and live harp music therapy had a significantly beneficial effect on maternal anxiety
score (46.8 vs 27.7 +/- 7.1respectively, p<0.01). Infant’s physiological responses and
behavior did not differ significantly. It was concluded that kangaroo care combined with
live harp music therapy is more beneficial in reducing maternal anxiety.
Farhat (2010) has conducted a study to investigate the effect of lullaby music on
the physiologic response and weight gain of premature infants in NICU of Imamreza
Hospital, Iran. About 44 very low birth weight infants <34 weeks of gestational weeks
admitted to NICU were selected and randomly assigned to two groups. Lullaby music
was played through ear phones, continued for 8 days at 20 minutes per day. Infants were
monitored for 40 minutes; 10 minutes baseline, 20 minutes into the intervention and 10
minutes post intervention. Heart rate, Respiratory rate, Oxygen saturation and body
weight were measured. The result showed the there is a significant difference between the
two groups, respiratory rate (p=0.01) and oxygen saturation (p=0.001). There was no
significant difference in the heart rate (p=0.24) and weight gain (p=0.093). It was
concluded that the preterm infants respond to lullaby music as evidenced by the changes
in their respiratory rate and oxygen saturation.
24
Cassidy JCU (2009) has conducted a study regarding the effect of decibel level
of music stimuli and gender on head circumference and physiological responses of
premature newborns in the NICU, between the gestational age of 28 and 33 weeks. 63
premature infants in the NICU were selected, half of the experimental infants listened to
20 minutes of lullaby music on 2 days followed by 20 minutes of classical music on 2
days. The other half listened to the same music in the reverse order. One quarter of males
and one quarter of females listened to music presented at an average of 65db, one quarter
at an average of 70db, and one quarter at an average of 75db and one quarter served as a
control group. The head circumferences data were collected on the first day of music, on
the last day of music and first week after music presentation. Physiological data(heart
rate, respiratory rate, oxygen saturation) were recorded at 2 minute interval starting 4
minute prior to and ending 4 minute after music presentation. There was a significant
difference (P<.0001) in average daily head growth across time, when compared to control
group infants. Results indicate a significant (P=.002) decrease in the heart rate over
course of data collection, no difference due to gender were noted.
Lubetzky R and Dollbery S (2009) has conducted a prospective crossover study
to determine the effect of music by Mozart on Energy Expenditure in Growing preterm
infants. 20 healthy-appropriate-weight for-gestational-age, gavage fed preterm infants
were selected and they were randomly assigned to be exposed to a 30 minute period of
Mozart music. Metabolic measurements were performed by indirect calorimetry. The
result revealed that the REE (Resting Energy Expenditure) was similar during first 10
minute period of both groups. During the next 10 minute period, infants who were
exposed to music had a significantly lower REE than when not exposed to music
(p=0.28) and during the third 10 minute period p=0.3. Thus on average, the effect of
music on REE is a reduction of approximately 10% to 13% from baseline, an effect
obtained within 10 to 30 minutes. It was concluded that exposure to Mozart music
25
significantly lowers REE in healthy preterm infants. This effect of music on REE might
explain, in part, the improved weight gain that result from the “Mozart effect”.
Chou and Wang (2003) in Tri-service General Hospital, China has conducted a
study to assess the effect of Music therapy on oxygen saturation in premature infants
receiving endotracheal suctioning. A sample of 30 infants were selected from three
NICU. The oxygen saturation of all the babies was measured while they were receiving
endotracheal suctioning during a four- hour control period with regular care. Then after
the music “transitions” were played. One minute before suctioning, the level of oxygen
saturation was measured which provides the baseline data. During the period of 30
minute after the suctioning the oxygen saturation levels were recorded every minute to
analyze the clinical effect of music therapy. The result showed that the premature infants
receiving the music therapy with endotracheal suctioning had a significantly higher
oxygen saturation than that when not receiving music therapy (p<0.1)and the level of
oxygen saturation returned to the baseline level faster than when they did not receive
music therapy (p<0.01). It was concluded that giving appropriate music therapy as
developmental care to premature infants enhance the quality of infant’s life.
Bol L.K (2000) has conducted a study to determine the effect of Non-
Nutritive sucking (NNS) and music therapy(MT) on Heart rate, Transcutaneous oxygen
levels and pain behavior of neonates in NICU in a government funded hospital in Hong
kong. The study sample include 27 neonates. The result showed that repeated-measures
multivariate analysis of variance revealed statistically significant differences in outcomes
across all interventions [Wilk’s lambda =0. 142; F{3,27}=31.82; eta 2=0.47]. One way
analysis of variance revealed that the 3 comfort intervention significantly reduced
Neonate’s Heart rate [Wilk’s lambda=0.647; F{2,27}=18.93; eta2=0.35], improved their
Transcutaneous oxygen levels [Wilk’s lambda=0.481; F{2,27}=37.42; eta2=0.51] and
26
reduced pain levels[Wilk’s lambda=0.312; F{2,27}=76.42; eta=0.68]. Posthoc Scheffe
test revealed that NNS+MT has the strongest effect on neonates’ heart rate. It was
concluded that using NNS+MT when doing heel sticks can improve the Transcutaneous
oxygen levels of neonates and reduce their pain and using MT alone can improve the
Heart rate of the Neonates.
Standley JM (1998) has conducted a qualitative study among the preterm infants
in level III Newborn Intermediate Care Unit in Florida State Hospital, Tallahassee, USA
regarding the effect of music and multimodal stimulation on responses of premature
infants. 40 infants were studied and they are grouped into control and experimental
groups based on gender, birth weight, gestational age at birth and severity of medical
conditions. The experimental group received reciprocal, multimodal stimulation paired
with line singing of Brahm’s lullaby. Stimulation was provided for 15-30 minutes, one or
two times per week. Result showed that music and multimodal stimulation significantly
benefited females’ days to discharge and increased weight gain per day for both males
and females. Both male and female infant’s tolerance for stimulation showed marked and
steady increase across the stimulation interval with female’s tolerance increasing more
rapid than male infants.
27
SECTION-III:STUDIES RELATED TO MUSIC THERAPY AND
PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN OF
PREMATURE NEWBORNS:
Silva and Jessica (2013) has conducted a study to evaluate the physiologic effects
of music therapy in preterm babies in NICU of University Hospital, of Doutor Helio
Mandetta Medical school of Brazil. A non-controlled clinical trial including 12 newborn
infants with a gestational age of < 36 weeks of spontaneously breathing were selected for
the study. These preterm infants were submitted to 15 minute sessions of classical music
therapy twice a day (morning and afternoon) for 3 consecutive days. The Heart rate,
Respiratory rate, Oxygen saturation, Systolic and Diastolic arterial pressures and body
temperature were analyzed before and immediately after the music therapy session. The
result was found to be present with a decrease in the Heart rate after the 2nd session of
music therapy (p=0.002) and an increase at the end of 3rd session (p=0.005). Respiratory
rate decreased during the 4th and 5th sessions (p=0.01 and p=0.03). Regarding the Oxygen
saturation there is an increase after the 5th session (p=0.008). It was concluded that the
music therapy may modify short-term physiological responses of preterm infants.
Loewy (2013) has conducted a study to determine the effect of music therapy on
vital signs, feeding and sleep in premature infants, in Hudson valley Health care system,
Castle point, New York. A randomized clinical multisite trial of 272 premature infants
aged > 32 weeks with respiratory distress syndrome, clinical sepsis, and or SGA (small
for gestational age) served as their own controls in 11 NICUs. Infants received 3
interventions per week within a 2 week period, when data of physiologic and
developmental domains were collected before, during, and after the interventions or no
intervention. The result showed that three live music interventions showed changes in
heart rate interactive with time. Lower heart rate occurred during the lullaby (p<0.001)
28
and rhythm intervention (p=0.04). Sucking behavior showed differences with rhythm
sound interventions (p=0.03). Entrained breath sounds rendered lower heart rates after the
intervention (p=0.04) and differences in sleep patterns (p<0.001), caloric intake (p=0.01)
and sucking behavior (p=0.02) were parent preferred lullabies. Music decreased parental
stress perception (p<0.001). It was concluded that the intentional therapeutic use of live
sound and parent preferred lullabies can influence cardiac and respiratory function.
Entrained with a premature infant’s observed vital signs, sound and lullaby may improve
feeding behavior and sucking patterns and it may also increase prolonged periods of
quiet-alert states. Parent-preferred lullabies, when sang live, can enhance bonding, thus
decreasing the stress, parents associate with premature infant care.
Deepthimol (2011) has conducted a quasi experimental study to assess the
effectiveness of classical music therapy on the physiological and behavioral parameters
among the preterm neonates with respiratory distress, in NICU, Bangalore. About 50
preterm babies of gestational age between 30 to 36 weeks were selected for the study.
The data were collected from each sample for 4 consecutive days and the sample subject
act as their control group on alternate days. The observations regarding the physiological
and behavioral parameters were collected before and after classical music therapy at
specific time intervals. Respiratory distress was assessed by Downey’s score at specific
time intervals. The result showed that there is a significant increase in the Oxygen
saturation from the mean oxygen saturation of 93+/- 1.2 before music to 96+/-0.4 after
music therapy. Also there is a significant decreased heart rate from 140.2+/-4.6 before
music to 132.2+/-2.4 after music therapy. The preterm babies were found to have
decreased crying spells. It was concluded that the classical music therapy was effective
among the preterm neonates when given at the appropriate time.
29
Johnston and Filion (2007) has conducted a study regarding the effectiveness of
recorded maternal voice for preterm neonates undergoing heel lance. The study included
20 infants who were in between 32-36 weeks of gestation. The infants were exposed to
the recorded mother’s voice for 10 minutes, 3 times a day after feedings. Then the infant
was a heel lance, the infant’s Heart rate and oxygen saturation level prior to heel lance,
during and after the heel lance were recorded. It was found that the mean oxygen
saturation level was increased during the third day of the intervention when comparing to
the mean oxygen level of the first day of the intervention. (96.2 vs 94.1) therefore the
result suggest that the female singing results in increased levels of oxygen.
Arnon (2006) has conducted a study to assess the effectiveness of live
music therapy on the physiological parameters and behavioral pattern(sleeping state)
of the preterm newborns in NICU. 31 stable infants were randomly selected and
they were given live music, recorded music and no music therapy over 3 consecutive
days for about 30 minutes. The infant’s Heart rate, Respiratory rate, Oxygen saturation
and behavioral assessment were done. The study revealed that there is a significant
reduced heart rate( 150 +/-3.3 beats before therapy vs 127 +/- 6.5 beats after therapy)
and improved behavioral score ( 3.1 +/- 0.8 before therapy vs 1.3 +/- 0.6 after
therapy, p< 0.001). The study concluded that live music therapy is associated with a
reduced heart rate and a deeper sleep in the stable preterm infants.
Paul and Gupta (1999) has conducted a study to determine the immediate cardio-
respiratory effects of classical music therapy in preterm neonates in NICU, AIIMS,
Delhi. 41 preterm neonates of gestational weeks 32.7+/- 1.7 weeks and birth weight of
1620 +/- 230gm were selected respectively and given classical music therapy for a period
of 60 minutes for 3 days. Day 2 was the control period and no music was played. The
baby’s Heart rate, Oxygen saturation were recorded 15 minutes before music(BM), 30
30
minutes of music(MM), and 15 minutes post-music(PM).The result showed that on day 1
and 3, Heart rate value were significantly lowered during the music (MM) and post-
music(PM) phases when compared to before music (BM). BM=144+/-5, MM=137.0+/-
4.6 and PM=135.0+/-4.2; BM vs MM p<0.05, BM vs PM p<0.05. On day 3, Heart rate
measured was BM=144.8+/-5.3, MM=137.6+/-3.9, PM=134.1+/-3.6, BM vs MM p<0.05,
BM vs PM p<0.05. On contrast on day 2 of study with no music there was no differences
in the mean heart rate during the 3 phases of observation. BM=144.5+/-4.7,
MM=144.7+/-5.2, PM=144.6+/-5.3. BM vs MM and BM vs PM is not significant. The
mean Oxygen saturation value on day 1 were significantly higher during music and post-
music phases than before music session. BM= 95.43+/-0.31, MM=96.4+/-0.3,
PM=96.0+/-0.4. BM vs MM p<0.05, BM vs PM p<0.05. On day 3 also, BM=94.6+/-0.2,
MM=96.0+/-0.15, PM=95.7+/-0.2. BM vs MM p<0.05, BM vs PM p<0.05. In contrast,
there is no differences in Oxygen saturation values in 3 phases on day 2, BM=94.7+/-0.3,
MM=94.3+/-0.4, PM=94.5+/-0.3. BM vs MM and BM vs PM is not significant. So it
was concluded that listening to classical music therapy, there is significant improvement
in Oxygen saturation (by 1-1.4%) and lowering Heart rate (by 5-5.6%) and therefore it
was found that Music therapy was useful to achieve stress relaxation for babies in NICU.
31
CHAPTER – 3
RESEARCH METHODOLOGY
Research methodology is a way to solve the problem systematically. It
considers the logic behind the methods used in the context of the research study.
Methodology is a significant part of research under which the researcher is able
to plan the blue print of the research taken. Thus research results are capable of
being evaluated either by the researcher themselves or by the others.
This chapter deals with the methods adopted for the study and includes the
description of research design, settings of the study, population, variables, sample
size, sampling technique, criteria for sample selection, the inclusion and exclusion
criteria, the development of the tool, collection of data, pilot study and plan for
data analysis.
RESEARCH APPROACH:
The selection of research approach is the basic procedure for the conduction
of research enquiry. A research approach tells us such as what data to be
collected and how it should be analyzed. It also suggests possible conclusions to
be drawn from the data. According to Treece and Treece (1986), the approach to
research is the umbrella which covers the basic procedure for conducting the
research.
32
Research approach is a systematic, controlled empirical and critical
investigation of natural phenomena guided by theory and hypothesis about
presumed relation among the phenomena. The research approach used for this
study was quasi experimental approach.
RESEARCH DESIGN:
According to Nancy Burns, the research design is a blue print for
conducting a study that maximizes control over factors that could interfere with
the validity of the findings.
The research design selected for the present study was Quasi Experimental
Non-Randomized control group which is relatively straight forward research design
in which there is an experimental group and a control group in which samples
are selected by purposive sampling technique. All the subjects were given the
pretest, and the experimental group received the treatment and the control group
received no treatment, and post test were conducted for both the group.
33
Experimental Group
Pre test
No intervention
Post test
Target Population Premature newborn, admitted in NICU
Accessible population: Premature newborn admitted in NICU of care 24 hospital, Erode.
Demographic variables: -Gestational weeks - Age -Birth weight -Cry at birth -APGAR score -Gender -Religion -Residential Area -Educational status of Mother - Occupational status of mother
Sample and sample size: Premature newborns (N=50)
Data collection: Self structured Questionnaire, modified BISQ and PIBBS Scale.
Sampling Technique:
Purposive sampling
Pre test
Intervention: Music therapy
Post test
Control Group
Data Analysis and interpretation:
Descriptive and inferential statistics
Findings
Report - Thesis
Criterion Measures :
Score on physiological parameters, feeding and sleeping scores
Figure -2 Schematic representation of Research Design
34
RESEARCH DESIGN NOTATION
GROUP
PRE TEST
INTERVENTION
POST TEST
Experimental group
O 1
X
O 2
Control group
O 1
_
O 2
The symbols used:
O 1: Pre test to assess the level of physiological parameters, feeding and sleeping
pattern among preterm newborns in experimental and control groups.
X : Music therapy
O 2: Post test to assess the effect of Music therapy among preterm in
experimental and control group.
VARIABLES
According to Suresh K Sharma (2011) variables are the qualities, properties or
characteristics of a person, things or situations that change or vary. Variables are
concepts at different level of abstraction that are concisely defined to promote
their measurement within study.
35
INDEPENDENT VARIABLE
Variables that are purposely manipulated or changed by the Researcher. It is
also called as manipulated variable. In the present study Music therapy is an
independent variable.
DEPENDENT VARIABLE
Variable that changes as the independent variable is manipulated by the
researcher. It is also termed as the criterion. In the present study the
physiological parameters, feeding and sleeping pattern among the preterm newborns
were the dependent variable.
DEMOGRAPHIC VARIABLES
Existing characteristics of the research subjects such as gestational weeks of
the newborn, age of preterm newborn, birth weight, birth order, cry of the child at
birth, APGAR score, gender, religion, residential area, educational status of the
mother, occupational status of the mother.
36
SETTING OF THE STUDY
According to Polit and Beck (2004) setting is the more specific places where
data collection occurs. The selection of setting was done on the basis of
feasibility of conducting the study, availability of the subject and cooperation of
authority. The study was conducted in the NICU of CARE-24 Hospital at Erode.
POPULATION
Polit and Beck (2012) stated that the term population refers to the
aggregate or totality of all subjects or members that confirm to a set of
specifications. Population may be of two types - target population and accessible
population.
Target population refers to the population that the researcher wishes to
make a generalization. In this study the target population were the preterm
newborns admitted in the NICU.
Accessible population refers to the aggregate cases which confirm to
the designed criteria and which is accessible to the researcher as the pool of
subject or object. In this research the accessible populations were the preterm
newborns admitted in the NICU of the CARE-24 Hospital at Erode.
37
SAMPLE AND SAMPLE SIZE
Polit and Beck (2004) stated that a sample consists of the subset of the
population selected to participate in the research study. Sample size is the number
of people participating in the study. The sample size is determined based on the
type of the study, variable being studied, the statistical significance required, and
availability of samples and feasibility of conducting the study. The sample include
male and female preterm babies who fulfilled the sample selection criteria. The
sample size for this study consists of 50 samples.
SAMPLING TECHNIQUE
In present study purposive sampling technique was used. It is one of the non-
probability or non-random method in which the deliberate selection of sample units
that confirm to some predetermined criteria. Purposive sampling is also termed as
judgmental or theoretical sampling.
SAMPLE SELECTION CRITERIA
The study samples were selected using the following criteria
INCLUSION CRITERIA
Preterm newborns of gestational weeks between 30-36.
Preterms who were on breastfeeding.
Mothers who were willing to participate in the study.
38
EXCLUSION CRITERIA
Preterms who were critically ill.
Mothers who were not willing to participate in the study.
DEVELOPMENT OF THE TOOL
The tool is the written device that a researcher assess to collect the data.
After careful and detailed review of literature the researcher prepared and
developed a structured interview schedule and modified BISQ, PIBBS scale as a
tool for the present study. Reliability of the tool was tested prior to pilot study.
The tool comprised of two sections namely section-1 demographic variable and
section-2 is a self structured questionnaire, modified BISQ and PIBBS scale.
DESCRIPTION OF TOOL
Description of the tool refers to the explanation of the content of the tool.
The researcher lists the number of items and the scoring for each item in the
tool. The tool used for the present study has two sections.
Section-1 Demographic variable
This section consists of self structured questionnaire about the demographic
details of the newborn and the mother. It consists of gestational weeks of the
39
newborn, age of preterm newborn, birth weight, birth order, cry of the child at birth,
APGAR score, gender, religion, residential area, educational status of the mother,
occupational status of the mother.
Section-2 Self structured questionnaire with Modified BISQ and PIBBS Scale
It includes three sub parts. A) self structured questionnaire to evaluate the
physiological parameters (Heart rate, Respiratory rate, SPO2) of the premature
newborns. It includes 3 questions and scored by the range of 1-3 and interpreted as
normal, irritable, restless.
B) The Preterm Infant Breastfeeding Behavior Scale (PIBBS) is an
instrument specially designed for the preterm infants. It consists of 6 items in
which the scoring is made by the use of rating scale with different range. The
range of score is 0-20 and interpreted as poor , fair and good intake
C) The Brief Infant Sleep Questionnaire (BISQ) is an instrument designed
for the pediatric population. It consists of 7 questions regarding the sleep pattern
of the infants. Scoring is made by the use of rating scale with the range of score
0 – 4 and interpreted as poor , moderate and good sleep.
The total score of the developed tool is 50 and it is interpreted as follows.
40
Score interpretation
Total score - 50
Least score - 0
VALIDITY OF THE TOOL
Validity of the tool refers to the degree to which the test or other
measuring device is truly measuring what it is indented to measure. The important
aspect in assessing an instrument is content validity, criteria validity and
construction validity.
The Content validity of the data collection tool and intervention tool
was ascertained by opinion of experts in the field. It is validated by three child
health nursing specialities, two peadiatrician . Suggestions were considered and
modified according to the opinion of the experts.
PERCENTAGE SCORE INTERPRETATION
0 – 33 % 0 – 16 Poor improvement
34 – 67 % 17 – 33 Fair improvement
68 – 100 % 34 – 50 Good improvement
41
RELIABILITY OF THE TOOL
Polit and Hungler define reliability as the degree of consistency or
accuracy with which an instrument measures the attribute it is designed to
measure. Inter rater reliability was used to establish the reliability among 10
samples. Reliability was computed using Test – retest method for Modified BISQ
scale, the reliability was found to be T = 0.95. Reliability was computed using Karl
Pearson’s Correlation Coefficient method. The reliability was found to be r = 0.64
for modified PIBBS scale. The tool was found to be highly reliable to proceed with
the main study.
PILOT STUDY
The pilot study is the miniature trial run of the methodology planned
for the majority research study, which facilitates to improve the methodology of
the study and may identify the problems that may be faced by the researcher in
actual larger research project. It was conducted to find out feasibility, practicability,
validity, and reliability of the study.
The pilot study was conducted in CARE – 24 Hospital with prior
permission from the authorities obtained. Informed consent was obtained from 10
samples, who fulfilled the inclusive criteria using purposive sampling method. A
42
brief explanation was given about the intervention and purpose of the study to the
participants. The intervention was given 7 days for the samples and data was
collected by interviewing and using the scale. Privacy and confidentiality was
ensured. The study was found to be feasible in terms of availability of samples,
cooperation of the institution, times, distance, money and material.
DATA COLLECTION PROCEDURE
Phase I Screening phase
The study was conducted in CARE – 24 Hospital. data were collected in
the month of June-July 2016, and official permission was obtained from the
authorities before to conduct the study.
Screening of the preterm newborns was done by using the BISQ and
PIBBS scale. Total of 50 babies who fulfilled the selection criteria were selected
by purposive sampling in which 25 were in experimental group and another 25
were in control group. To assess each preterm newborn it took 5 minutes.
Phase II Data collection phase and Implementation phase
After identification of the preterm newborns, the purpose and the
procedure of the data collection and music therapy was explained to the mothers
43
and care givers and the written informed consent was obtained from them and
confidentiality was ensured. The investigator interviewed the mothers with proper
privacy to collect information on demographic variables. 25 babies in experimental
group were given music therapy for 15 minutes, consecutively for 3 days. Then
post evaluation was done by the same BISQ and PIBBS scale. After the music
therapy the physiological parameters and the feeding pattern was improved and
also there was decreased crying periods during the sleeping. This phase lasted for
15 – 20 minutes.
Phase III Termination phase
The tool was verified for completion. The mothers were assured about
the confidentiality of the data. The baby was made comfortable. This phase lasted
for a period of 5 minutes per baby and the mother.
44
PLAN FOR DATA ANALYSIS
Data analysis is the systematic organization and synthesis of research data
and testing of the research hypothesis using the data.
The data collected from the subjects were complied and analyzed using
descriptive and inferential statistics.
Data on demographic variables of the experimental and control group
was analyzed by using Frequency and Percentage.
Data of the physiological parameters , feeding and sleeping pattern
among the preterm newborn of the experimental and control group were
analyzed by Mean and Standard deviation
Data of the post test level of the physiological parameters, feeding and
sleeping pattern among the experimental group were analyzed by paired
‘t’ test.
Data on the association between the post test level of the physiological
parameters, feeding and sleeping pattern and their selected demographic
variables among the experimental group were analyzed by chi square.
45
ETHICAL CONSIDERATION
Ethical considerations were taken into account for the purpose of the study to
assess the physiological parameters, feeding and sleeping pattern among preterm
newborn in the selected hospital. The baby’s mother and the family members were
informed about the purpose of the study and confidentiality was promised and
ensured. The mother was given full freedom to decide on whether to participate in
the study or not. No physical or physiological harm was produced.
46
CHAPTER – 4
DATA ANALYSIS AND INTERPRETATION
MUSIC SPEAKS WHAT CANNOT BE EXPRESSED, SOOTHESS THE MIND AND GIVES REST, HEALS THE HEART AND MAKES IT WHOLE FLOWS FROM HEAVEN TO SOUL….
Data analysis is the method of organizing data in such a way that the
research questions can be answered. Interpretations is the process of making sense
of the result and of examining the implications of the findings within a broader
context. This chapter deals with the analysis and interpretation of the data
collected before and after the music therapy.
The analysis was done manually by the investigator and validated by the
Bio-statistician. The probability value of p<0.05 was considered to be significant.
THE OBJECTIVES OF THE STUDY:
To assess the pre and post test level of physiological parameters, feeding and
sleeping pattern among the experimental and control group.
To compare the pre and post test level of physiological parameters,
feeding and sleeping pattern among the experimental and control group.
47
To assess the effectiveness of music therapy on the pre and post test level of
physiological parameters, feeding and sleeping pattern among the
experimental group.
To find the association between the post test level of physiological
parameters, feeding and sleeping pattern and their selected demographic
variables among the experimental group.
THE DATA ANALYSED WERE PRESENTED AS FOLLOWS
Section 1: Data on selected Demographic variables of the Premature Newborns in
the experimental and control group.
Section 2: Data on comparison of Physiological parameter, Feeding and Sleeping
pattern among Premature Newborn among experimental and control group.
Section 3: Data on the Effectiveness of Music therapy on the Physiological
parameters, Feeding and Sleeping pattern among the Premature Newborns.
Section 4: Data on the association of Post test level of Physiological parameters,
Feeding and Sleeping pattern and their selected demographic variables among
experimental group.
48
SECTION 1: DATA ON SELECTED DEMOGRAPHIC VARIABLES OF THE PREMATURE NEWBORNS IN THE EXPERIMENTAL AND CONTROL GROUP
TABLE 1: FREQUENCY AND PERCENTAGE DISTRIBUTION OF SELECTED DEMOGRAPHIC VARIABLES OF THE EXPERIMENTAL AND CONTROL GROUP
S. no
Demographic variables
Experimental group Control group
Freq % Freq % 1. Gestational weeks
a. Below 30 weeks b. 31 - 33 weeks c. 34 - 36 weeks
0 4 21
0 16% 84%
0 3 22
0 12% 88%
2. Age of Premature Newborn
a. 1 - 7 days b. 8 – 14 days c. 15 – 21 days d. 22 – 28 days
9 5 8 3
36% 20% 32% 12%
8 4 9 4
32% 16% 36% 16%
3. Birth weight
a. 2 – 1.751 kg b. 1.750 – 1.501 kg c. 1.500 – 1.251 kg d. > 1.250 kg
20 5 0 0
80% 20% 0 0
20 5 0 0
80% 20% 0 0
4. Birth order
a. One b. Two c. Three
20 5 0
80% 20% 0
17 8 0
68% 32% 0
49
5. Cry of the child at birth
a. Did not cry b. Weak cry c. Cried well
0 7 18
0 28% 72%
0 7 18
0 28% 72%
6. APGAR score
a. 0 – 3 b. 4 – 6 c. 7 - 10
0 7 18
0 28% 72%
0 8 17
0 32% 68%
7. Gender
a. Male b. Female
14 11
56% 44%
15 10
60% 40%
8. Religion
a. Hindu b. Muslim c. Christian
14 5 6
56% 20% 24%
13 6 6
52% 24% 24%
9. Residential area
a. Urban b. Rural
16 9
64% 36%
15 10
60% 40%
10. Educational status of Mother
a. Primary b. Secondary c. Higher secondary d. Graduate e. Illetrate
0 0 10 15 0
0 0 40% 60% 0
0 0 11 4 0
0 0 44% 56% 0
50
11. Occupational status of Mother
a. Private employee b. Government employee c. Own business d. At home
9 5 5 6
36% 20% 20% 24%
10 3 5 7
40% 12% 20% 28%
Table 1- shows the frequency and percentage distribution of the selected demographic variables of the premature newborns in the experimental and control group.
Regarding the gestational weeks, in experimental group, majority 21 (84%)
were between 34 -36 weeks and least 4 (16%) were between 31 – 33 weeks. Among
the control group majority 22 (88%) were between 34 – 36 weeks and least 3 (12%)
were between 31 – 33 weeks respectively.
Regarding the age of the premature newborn, in experimental group,
majority 9 (36%) were between 1 – 7 days, 8 (32%) were between 15 – 21 days,
5 (20%) were between 8 – 14 days and least 3 (12%) were between 22 – 28 days.
Among the control group, majority 9 (36%) were between 15 – 21 days, 8(32%)
were between 1 – 7 days, and least 4 (16%) were present equally between 8 – 14
days and 22 – 28 days.
Regarding the Birth weight, in the experimental group, majority 20(80%) had
2 – 1.751 kg and least 5 (20%) had 1.750 – 1.501 kg weight. among the control
group, majority 20 (80%) had 2 – 1.751 kg and least 5 (20%) had 1.750 – 1.501 kg
weight respectively.
51
Regarding the Birth order, in experimental group, majority 20 (80%) were
One and least 5 (20%) were Two. Among the control group, majority 17 (68%)
were One and least 8 (32%) were Two respectively.
Regarding the cry of the child at birth, in experimental group, majority 18
(72%) had cried well and least 7 (28%) had a weak cry. Among the control group,
majority 18 (72%) had cried well and least 7 (28%) had a weak cry respectively.
Regarding the APGAR score, in experimental group, majority 18 (72%) had
a score between 7 – 10 and least 7 (28%) had a score between 4 – 6. Among the
control group, majority 17 (68%) had a score between 7 – 10 and least 8 (32%) had
a score between 4 – 6 respectively.
Regarding gender, in experimental group, majority 14 (56%) were males and
least 11(44%) were females. Among the control group, majority 15 (60%) were
males and least 10 (40%) were females respectively.
Regarding religion, in experimental group, majority 14 (56%) belongs to
Hindu, 6 (24%) belongs to Christian and least 5 (20%) belongs to Muslim. Among
the control group, majority 13 (52%) belongs to Hindu and least 6 (24%) belongs
to both Christian and Muslim respectively.
52
Regarding the residential area, in experimental group, majority 16 (64%)
belong to urban and least 9(36%) belong to rural area. Among the control area,
majority 15 (60%) belong to urban and least 10 (40%) belong to rural area
respectively.
Regarding the educational status of mother, in experimental group, majority
15 (60%) were graduates and least 10 (40%) had higher secondary education.
Among the control group, majority 14 (56%) were graduates and least 11 (44%)
had higher education respectively.
Regarding the occupational status of mother, in experimental group,
majority 9 (36%) were private employee, 6(24%) were in home and least 5 (20%)
were government employee and 5 (20%) do own business. Among the control
group, majority 10 (40%) were private employee, 7 (28%) were in home, 5 (20%)
were doing own business and least 3 (12%) were government employee
respectively.
It was inferred that, in experimental group, majority 21 (84%) were
between 34 – 36 weeks of gestation, 9(36%) were between 1 – 7 days of age, 20
(80%) had a birth weight of 2 – 1. 751 kg, 20 (80%) were of birth order one, 18
(72%) cried well at birth, 18 (72%) had a APGAR score between 7 – 10, 14 (56%)
were males, 14 (56%) belong to Hindu, 16 (64%) belong to urban residential area,
15 (60%) mothers were graduate and 9 (36%) mothers were private employees
respectively.
53
Among the control group, majority 22 (88%) were between 34 – 36 weeks of
gestation, 9 (36%) were between 15 – 21 days of age, 20 (80%) had a birth weight
of 2 – 1. 751 kg, 17 (68%) were of birth order one, 18 (72%) cried well at birth,
17 (68%) had a APGAR score between 7 – 10, 15 (60%) belong to Hindu, 15
(60%) belong to urban residential area, 14 (56%) mothers were graduate and 10
(40%) mothers were private employees respectively.
54
SECTION 2: DATA ON COMPARISON OF PHYSIOLOGICAL PARAMETER, FEEDING AND SLEEPING PATTERN AMONG PREMATURE NEWBORN AMONG EXPERIMENTAL AND CONTROL GROUP.
TABLE 2: MEAN, SD OF THE POST TEST LEVEL OF PHYSIOLOGICAL PARAMETERS OF THE EXPERIMENTAL AND CONTROL GROUP.
N= 25
GROUP
EXPERIMENTAL GROUP CONTROL GROUP
POST TEST POST TEST
HR RR SPO2 HR RR SPO2
MEAN
141
29
95
148
34
92
SD
4.9
2.6
1.07
6.4
2.8
1.05
Table 2 shows the mean, standard deviation of the post test level of physiological parameters of the premature newborns in the experimental and control group.
In the experimental group, the overall post test mean HR was 141, SD
was 4.9, mean RR was 29, SD was 2.6, mean SPO2 was 95, SD was 1.07
whereas in the control group, the overall post test mean HR was 148, SD was 6.4,
mean RR was 34, SD was 2.8, mean SPO2 was 92, SD was 1.05 respectively.
55
It was inferred that the post test level physiological parameters was
lower (HR, RR) and higher (SPO2) in the experimental group than the control
group. Hence the Music therapy was found to be effectiveness in improving the
Physiological parameters of the premature newborns respectively.
56
FIGURE 3: FREQUENCY AND PERCENTAGE DISTRIBUTION OF PRE TEST AND POST TEST LEVEL OF FEEDING PATTERN IN EXPERIMENTAL AND CONTROL GROUP.
Figure 3 shows the frequency and percentage distribution of the pre test and post test level of feeding pattern among the premature newborns of the experimental and control group
Among the experimental group, in the pre test 8 (32%) had poor intake
and 17 (68%) had a fair intake of feeding whereas in the post test, 4 had a fair
intake and 21 (84%) had a good intake of feeding.
Among the control group, in the pre test 10 (40%) had poor intake and
15 (60%) had a fair intake of feeding whereas in post test, 8 (32%) had poor
intake and 17 (68%) had a fair intake of feeding respectively.
POOR INTAKE FAIR INTAKE GOOD INTAKE
32%
68%
00
16%
84%
40%
60%
0
32%
68%
0
FEEDING PATTERNEXP.PRE EXP.POST CON.PRE CON.POST
57
TABLE 3: MEAN, SD, MEAN DIFFERENCE, UNPAIRED t VALUE OF POST TEST LEVEL OF FEEDING PATTERN AMONG THE EXPERIMENTAL AND CONTROL GROUP.
N=50
GROUP
MEAN
SD
MEAN DIFFERENCE
UNPAIRED t VALUE
EXPERIMENTAL POST TEST
15
1.6
7
t = 15.09 Df=49 S
CONTROL POST TEST
8
1.6
Table 3 shows the mean, standard deviation, mean difference and unpaired t value of the post test level of the feeding pattern of the premature newborns among the experimental and control group.
The mean post test feeding score of the experimental group was 15, SD
was 1.6 and the mean post test feeding score of the control group was 8, SD was
1.6. The mean difference was 7. The obtained unpaired t value was 15.09 which is
significant at the level of p<0.05.
It was inferred that the post test level of feeding was higher in the
experimental group than the control group. The obtained unpaired t value, t=15.09
was significant at the level of p<0.05. Hence the music therapy was found to be
effective in improving the feeding pattern of the premature newborns.
58
FIGURE 4 : FREQUENCY AND PERCENTAGE DISTRIBUTION OF PRE TEST AND POST TEST LEVEL OF SLEEPING PATTERN IN EXPERIMENTAL AND CONTROL GROUP.
Figure 4 shows the frequency and percentage distribution of the pre test and post test level of sleeping pattern among the premature newborn of the experimental and control group.
Among the experimental group, in the pre test 10 (40%) had poor sleep
and 15 (60%) had moderate sleep whereas in the post test 5 (20%) had moderate
sleep and 20 (80%) had good sleep respectively.
Among the control group, in the pre test 9 (36%) had poor sleep and 16
(64%) had moderate sleep whereas in the post test, 7 (28%) had poor sleep and
18 (72%) had moderate sleep respectively.
POOR SLEEP MODERATE SLEEP GOOD SLEEP
40%
60%
00
20%
80%
36%
64%
0
28%
72%
0
SLEEPING PATTERNEXP.PRE EXP.POST CON.PRE CON.POST
59
TABLE 4: MEAN, SD, MEAN DIFFERENCE AND UNPAIRED t VALUE OF THE POST TEST LEVEL OF SLEEPING PATTERN AMONG THE EXPERIMENTAL AND CONTROL GROUP.
N=50
GROUP
MEAN
SD
MEAN DIFFERENCE
UNPAIRED t VALUE
EXPERIMENTAL POST TEST
16
1.9
7
t = 12.72 Df = 49 S
CONTROL POST TEST
9
2.1
Table 4 shows the mean, standard deviation, mean difference and unpaired t value of the post test level of sleeping pattern among the premature newborns of the experimental and control group.
The mean post test sleeping score of the experimental group was 16,
SD was 1.9 and the mean post test sleeping score of the control group was 9, SD
was 2.1. The mean difference was 7. The obtained unpaired t value was 12.72
which was significant at the level of p<0.05.
It was inferred that the post test level of sleeping was higher in the
experimental group than the control group. The obtained unpaired t value, t = 12.72
was significant at the level of p<0.05. Hence the music therapy was found to be
effective in improving the sleeping pattern of the premature newborns.
60
FIGURE 5: OVERALL FREQUENCY AND PERCENTAGE DISTRIBUTION OF PRE TEST AND POST TEST LEVEL OF PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN IN THE EXPERIMENTAL AND CONTROL GROUP
Figure 5 shows the overall frequency and percentage distribution of pre test and post test level of physiological parameters, feeding and sleeping pattern of the premature newborns of the experimental and control group.
Among the experimental group, in the pre test 8 (32%) were in poor
improvement and 17 (68%) were in fair improvement to music whereas in the
post test 4 (16%) were in fair improvement and 21 (84%) were in good
improvement to music respectively.
Among the control group, in the pre test 10 (40%) were in poor
improvement and 15 (60%) were in fair improvement whereas in post test 7
(28%) were in poor improvement and 18 (72%) were in fair improvement to music
respectively.
POOR IMPROVEMENT FAIR IMPROVEMENT GOOD IMPROVEMENT
32%
68%
00
16%
84%
40%
60%
0
28%
72%
0
PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN
EXP.PRE EXP.POST CON.PRE CON.POST
61
SECTION 3 : DATA ON THE EFFECTIVENESS OF MUSIC THERAPY ON THE PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN AMONG THE PREMATURE NEWBORNS.
TABLE 5: MEAN, SD OF THE PHYSIOLOGICAL PARAMETERS OF THE EXPERIMENTAL GROUP.
N= 25
EXPERIMENTAL GROUP
PRE TEST
POST TEST
HR RR SPO2 HR RR SPO2
MEAN
152
34
92
141
29
95
SD
6.3
3.4
1.07
4.9
2.6
1.07
Table 5 shows the mean and standard deviation of the physiological parameters of the premature newborns in the experimental group
In the experimental group, in pretest, the mean HR was 152, SD was
6.3; the mean RR was 34, SD was 3.4 ; the mean SPO2 was 92, SD was 1.07.
In the post test, the mean HR was 141, SD was 1.07 ; the mean RR was 29, SD
was 4.9 ; the mean SPO2 was 95, SD was 1.07.
It was inferred that post test mean score & SD are significantly reduced.
Hence, music therapy is effective in maintaining physiological parameters of
premature newborns.
62
TABLE 6: MEAN, SD, MEAN DIFFERENCE AND t VALUE OF PRE TEST AND POST TEST LEVEL OF FEEDING PATTERN OF THE EXPERIMENTAL GROUP.
N= 25
EXPERIMENTAL GROUP
MEAN
SD
RANGE
MEAN DIFFERENCE
PAIRED t VALUE
PRE TEST
7
1.3
4
8
20
POST TEST
15
1.6
5
Table 6 shows the mean, standard deviation, mean difference and t value of the pre test and post test level of feeding pattern of the premature newborns in the experimental group.
In the experimental group, the overall pre test mean feeding score was
7, SD was 1.3, range was 4 and the overall post test mean feeding score was 15,
SD was 1.6, range was 5. The mean difference was 8.
The obtained paired t value was 20 which was significant at the level
of p<0.05. Hence it was inferred that there is a significant difference in the pre
and post test level of feeding pattern among the premature newborn in the
experimental group. Hence the music therapy was found to be effective in
improving the feeding pattern of the premature newborns.
63
TABLE 7: MEAN, SD, MEAN DIFFERENCE AND t VALUE OF PRE AND POST TEST LEVEL OF SLEEPING PATTERN OF THE EXPERIMENTAL GROUP.
N= 25
EXPERIMENTAL GROUP
MEAN
SD
RANGE
MD
PAIRED t VALUE
PRE TEST
9
2.2
6
7
12.28
POST TEST 16
1.9
7
Table 7 shows the mean, standard deviation, mean difference and paired t value of pre and post test level of sleeping pattern of the premature newborns in the experimental group.
In the experimental group, the overall pre test mean sleeping score was
9, SD was 2.2, range was 6 and the overall post test mean sleeping score was
16, SD was 1.9, range was 7. The mean difference was 7.
The obtained paired t value was 12.28 which was significant at the
level of p<0.05. Hence it was inferred that there is a significant difference in the
pre and post test level of sleeping pattern among the premature newborns of the
experimental group respectively. Hence the music therapy was found to be
effective in improving the sleeping pattern of the premature newborns.
64
SECTION 4: DATA ON THE ASSOCIATION OF POST TEST LEVEL OF PHYSIOLOGICAL PARAMETERS, FEEDING AND SLEEPING PATTERN OF THE EXPERIMENTAL GROUP AND THEIR SELECTED DEMOGRAPHIC VARIABLES.
TABLE 8: ASSOCIATION BETWEEN THE POST TEST LEVEL OF FEEDING PATTERN OF THE EXPERIMENTAL GROUP AND THEIR SELECTED DEMOGRAPHIC VARIABLES.
S. NO
DEMOGRAPHIC VARIABLES
EXPERIMENTAL GROUP
CHI SQUARE
X2
SIGNIFICANCE
FREQ
%
1. Gestational weeks
a. Below 30 weeks b. 31 – 33 weeks c. 34 – 36 weeks
0 4 21
0 16% 84%
0.436
Df = 4 NS
2. Age of premature newborn
a. 1 – 7 days b. 8 – 14 days c. 15 – 21 days d. 22 – 28 days
9 5 8 3
36% 20% 32% 12%
5.153
Df= 6 NS
3. Birth weight
a. 2 – 1.751 kg b. 1.750 – 1.501 kg c. 1.500 – 1.251 kg d. > 1.250 kg
20 5 0 0
80% 20% 0 0
1.67
Df= 6 NS
4. Birth order
a. One b. Two c. Three
20 5 0
80% 20% 0
0.07
Df= 4 NS
65
5. Cry of the child at birth
a. Did not cry b. Weak cry c. Cried well
0 7 18
0 28% 72%
0.18
Df= 4 NS
6. APGAR score
a. 0 – 3 b. 4 – 6 c. 7 – 10
0 7 18
0 28% 72%
0.18
Df= 4 NS
7. Gender
a. Male b. Female
14 11
56% 44%
0.69
Df= 2 NS
8. Religion
a. Hindu b. Muslim c. Christian
14 5 6
56% 20% 24%
1.50
Df= 4 NS
9. Residential area
a. Urban b. Rural
16 9
64% 36%
2.67
Df= 2 NS
10. Educational status of mother
a. Primary b. Secondary c. Higher secondary d. Graduate e. Illterate
0 0 10 15 0
0 0 40% 60% 0
0.19
Df= 8 NS
66
11. Occupational status of mother
a. private employee b. government employee c. own business d. At home
9 5 5 6
36% 20% 20% 24%
2.51
Df= 6 NS
Table 8 shows the association between the post test level of feeding pattern of the premature newborns of the experimental group and their selected demographic variables.
Hence it was inferred that there was no significant association
between the post test level of feeding with their selected demographic variables
such as gestational weeks, age of premature newborns, birth weight, birth order,
cry of the child at birth, APGAR score, gender, religion, residential area,
educational status of mother and occupational status of the mother of the
premature in the experimental group.
67
TABLE 9 : ASSOCIATION BETWEEN THE POST TEST LEVEL OF SLEEPING PATTERN OF THE EXPERIMENTAL GROUP AND THEIR SELECTED DEMOGRAPHIC VARIABLES.
S. NO
DEMOGRAPHIC VARIABLES
EXPERIMENTAL GROUP
CHI SQUARE
X2
SIGNIFICANCE
FREQ
%
1. Gestational weeks
a. Below 30 weeks b. 31 – 33 weeks c. 34 – 36 weeks
0 4 21
0 16% 84%
0.073
Df = 4 NS
2. Age of premature newborn
a. 1 – 7 days b. 8 – 14 days c. 15 – 21 days d. 22 – 28 days
9 5 8 3
36% 20% 32% 12%
7.536
Df= 6 NS
3. Birth weight
a. 2 – 1.751 kg b. 1.750 – 1.501 kg c. 1.500 – 1.251 kg d. > 1.250 kg
20 5 0 0
80% 20% 0 0
1.562
Df= 6 NS
4. Birth order
a. One b. Two c. Three
20 5 0
80% 20% 0
0
Df= 4 NS
68
5. Cry of the child at birth
a. Did not cry b. Weak cry c. Cried well
0 7 18
0 28% 72%
0.446
Df= 4 NS
6. APGAR score
a. 0 – 3 b. 4 – 6 c. 7 – 10
0 7 18
0 28% 72%
0.446
Df= 4 NS
7. Gender
a. Male b. Female
14 11
56% 44%
1.459
Df= 2 NS
8. Religion
a. Hindu b. Muslim c. Christian
14 5 6
56% 20% 24%
2.142
Df= 4 NS
9. Residential area
a. Urban b. Rural
16 9
64% 36%
3.515
Df= 2 NS
10. Educational status of mother
a. Primary b. Secondary c. Higher secondary d. Graduate e. Illterate
0 0 10 15 0
0 0 40% 60% 0
0
Df= 8 NS
69
11. Occupational status of mother
a. private employee b. government employee c. own business d. At home
9 5 5 6
36% 20% 20% 24%
2.609
DF= 6 NS
Table 9 shows the association between the post test level of sleeping pattern of the premature newborns of the experimental group and their selected demographic variables.
Hence it was inferred that there was no significant association
between the post test level of sleeping with their selected demographic variables
such as gestational weeks, age of premature newborns, birth weight, birth order,
cry of the child at birth, APGAR score, gender, religion, residential area,
educational status of mother and occupational status of the mother of the
premature in the experimental group.
70
CHAPTER – 5
SUMMARY, FINDINGS, DISCUSSION, IMPLICATIONS,
LIMITATIONS, CONCLUSION AND RECOMMENDATIONS.
MUSIC GIVES A SOUL TO UNIVERSE, WINGS TO THE MIND,
FLIGHT TO THE IMAGINATION AND LIFE TO EVERYTHING.
The value of any research project lies in reporting its findings. This chapter
gives a brief account of the present study including conclusions, drawn from the
findings, recommendations, limitations of the study suggestions for further studies
and nursing implications.
SUMMARY:
The ultimate aim of the study is to assess the effectiveness of music therapy
on the physiological parameters, feeding and sleeping pattern among the premature
newborns.
71
The objectives of the present study were:
To assess the pre and post test level of physiological parameters, feeding and
sleeping pattern among the experimental and control group.
To compare the pre and post test level of physiological parameters, feeding
and sleeping pattern among the experimental and control group.
To assess the effectiveness of music therapy on the pre and post test level of
physiological parameters, feeding and sleeping pattern among the
experimental group.
To find the association between the post test level of physiological
parameters, feeding and sleeping pattern and their selected demographic
variables among the experimental group.
The study attempted to examine the following hypothesis.
H1: There is a significant difference in the post level of physiological parameter,
feeding and sleeping pattern between the experimental and control group.
H2: There is a significant association in the post level of physiological parameters,
feeding and sleeping pattern of the premature newborns of the experimental group
and their selected demographic variables.
72
The Review of literature was done for the present study and presented in
the following headings,
iv. Studies related to premature newborns.
v. Studies related to Music therapy in premature newborns.
vi. Studies related to Music therapy and physiological parameters, feeding and
sleeping pattern of premature newborns.
The conceptual framework for the present study is based upon Ernestine
Wiedenbach’s Art of clinical nursing theory. The research approach adopted for the
study was evaluative in nature.
It was a quasi experimental pre test and post test with non randomized
control group design. Independent variable was music therapy and dependent
variable was the physiological parameters, feeding and sleeping pattern of the
premature newborns.
The content validity was established by 4 experts. The reliability of the
tool was established by inter–rater and test-retest method. the reliability for PIBBS
scale is 0.64 and for modified BISQ was 0.95. The pilot study was conducted at
Care – 24 hospital at Erode, among 10 premature newborns who fulfilled the sample
selection criteria. The study was found to be feasible.
Prior permission from the authorities was sought and obtained; informed
written consent was taken from the mothers of the premature newborns after
explaining the purpose of the study. Based on the sample selection criteria, sample
were selected by purposive sampling technique. A total of 50 premature babies
73
were selected for the study, in which 25 babies in experimental group and 25 in
control group. The physiological parameters, feeding and sleeping pattern was
assessed by a self structured questionnaire, modified BISQ and PIBBS scale before
and after the Music Therapy in experimental group. Pre test and post test
observation score was recorded without any intervention in control group. Gathered
data were analyzed based on the objectives using descriptive and inferential
statistics by manually and validated by the Bio- statistician. The level of p<0.05
was considered to be significant.
FINDINGS
The major findings of the study were classified under following headings,
Findings - 1: Data on selected Demographic variables of the Premature Newborns
in the experimental and control group.
In experimental group, majority 21 (84%) were between 34 – 36 weeks of
gestation, 9(36%) were between 1 – 7 days of age, 20 (80%) had a birth weight of
2 – 1. 751 kg, 20 (80%) were of birth order one, 18 (72%) cried well at birth, 18
(72%) had a APGAR score between 7 – 10, 14 (56%) were males, 14 (56%) belong
to Hindu, 16 (64%) belong to urban residential area, 15 (60%) mothers were
graduate and 9 (36%) mothers were private employees.
Among the control group, majority 22 (88%) were between 34 – 36 weeks of
gestation, 9 (36%) were between 15 – 21 days of age, 20 (80%) had a birth weight
of 2 – 1. 751 kg, 17 (68%) were of birth order one, 18 (72%) cried well at birth,
74
17 (68%) had a APGAR score between 7 – 10, 15 (60%) belong to hindu, 15
(60%) belong to urban residential area, 14 (56%) mothers were graduate and 10
(40%) mothers were private employees.
Findings – 2: : Data on comparison of Physiological parameter, Feeding and
Sleeping pattern among Premature Newborn among experimental and control
group.
In the experimental group, the overall post test mean HR was 141, SD
was 4.9, mean RR was 29, SD was 2.6, mean SPO2 was 95, SD was 1.07
whereas in the control group, the overall post test mean HR was 148, SD was 6.4,
mean RR was 34, SD was 2.8, mean SPO2 was 92, SD was 1.05 respectively. It
was inferred that the post test level physiological parameters was lower (HR, RR)
and higher (SPO2) in the experimental group than the control group. Hence the
Music therapy was found to be effectiveness in improving the Physiological
parameters of the premature newborns respectively.
The mean post test feeding score of the experimental group was 15, SD
was 1.6 and the mean post test feeding score of the control group was 8, SD was
1.6. The mean difference was 7. The obtained unpaired t value was 15.09 which is
significant at the level of p<0.05. It was inferred that the post test level of feeding
was higher in the experimental group than the control group. The obtained
unpaired t value, t=15.09 was significant at the level of p<0.05. Hence the music
therapy was found to be effective in improving the feeding pattern of the
premature newborns.
75
The mean post test sleeping score of the experimental group was 16, SD
was 1.9 and the mean post test sleeping score of the control group was 9, SD
was 2.1. The mean difference was 7. The obtained unpaired t value was 12.72
which was significant at the level of p<0.05. It was inferred that the post test
level of sleeping was higher in the experimental group than the control group. The
obtained unpaired t value, t = 12.72 was significant at the level of p<0.05. Hence
the music therapy was found to be effective in improving the sleeping pattern of
the premature newborn.
Findings - 3: Data on the Effectiveness of Music therapy on the Physiological
parameters, Feeding and Sleeping pattern among the Premature Newborns.
In the experimental group, in pretest, the mean HR was 152, SD was
6.3; the mean RR was 34, SD was 3.4 ; the mean SPO2 was 92, SD was 1.07
respectively. In the post test, the mean HR was 141, SD was 1.07 ; the mean RR
was 29, SD was 4.9 ; the mean SPO2 was 95, SD was 1.07 respectively. It was
inferred that post test mean scores & SD were significantly reduced. Hence music
therapy is effective in maintaining physiological parameters of premature
newborns.
In the experimental group, the overall pre test mean feeding score was 7,
SD was 1.3, range was 4 and the overall post test mean feeding score was 15, SD
was 1.6, range was 5. The mean difference was 8. The obtained paired t value
was 20 which was significant at the level of p<0.05. It was inferred that there is
a significant difference in the pre and post test level of feeding pattern among the
premature newborn in the experimental group. . Hence the music therapy was
found to be effective in improving the feeding pattern of the premature newborns.
76
In the experimental group, the overall pre test mean sleeping score was 9,
SD was 2.2, range was 6 and the overall post test mean sleeping score was 16,
SD was 1.9, range was 7. The mean difference was 7. The obtained paired t
value was 12.28 which was significant at the level of p<0.05. It was inferred that
there is a significant difference in the pre and post test level of sleeping pattern
among the premature newborns of the experimental group. Hence the music
therapy was found to be effective in improving the sleeping pattern of the
premature newborn.
Findings - 4: Data on the association of Post test level of Physiological
parameters, Feeding and Sleeping pattern and their selected demographic variables
among experimental group.
There was no significant association between the post test level of
feeding pattern with their selected demographic variables such as gestational weeks,
age of premature newborns, birth weight, birth order, condition of child at birth,
APGAR score, gender, religion, residential area, educational status of mother and
occupational status of the mother of the premature in the experimental group.
There was no significant association between the post test level of
sleeping pattern with their selected demographic variables such as gestational
weeks, age of premature newborns, birth weight, birth order, condition of child at
birth, APGAR score, gender, religion, residential area, educational status of mother
and occupational status of the mother of the premature in the experimental group.
77
DISCUSSION:
The result of the study were discussed according to the objectives of the
study.
Objectives – 1 : To assess the pre and post test level of physiological parameters,
feeding and sleeping pattern among the experimental and control group.
In the experimental group, the overall post test mean HR was 141, SD
was 4.9, mean RR was 29, SD was 2.6, mean SPO2 was 95, SD was 1.07
whereas in the control group, the overall post test mean HR was 148, SD was 6.4,
mean RR was 34, SD was 2.8, mean SPO2 was 92, SD was 1.05.
The mean post test feeding score of the experimental group was 15, SD
was 1.6 and the mean post test feeding score of the control group was 8, SD was
1.6. The mean difference was 7.
The mean post test sleeping score of the experimental group was 16, SD
was 1.9 and the mean post test sleeping score of the control group was 9, SD
was 2.1. The mean difference was 7.
The above findings were consistent with the study done by Paul and
Gupta (1999). They conducted a study to determine the cardio – respiratory effects
of classical music therapy among preterm newborns. The study concluded that
78
listening to classical music therapy improved the oxygen saturation by 1 – 1.4% and
lowers heart rate by 5 – 5.6% among the preterm newborns.
Lubetzky and Dollbery (2009) in their study reported that exposing
the preterm infants to the Mozart music significantly lowers the REE and
improves the weight gain in the preterm infants.
Objectives – 2 : To compare the pre and post test level of physiological parameters,
feeding and sleeping pattern among the experimental and control group.
The post test level physiological parameters was lower (HR, RR) and
higher (SPO2) in the experimental group than the control group. It was inferred
that post test mean scores & SD were significantly reduced. Hence music therapy
is effective in maintaining physiological parameters of premature newborns.
In the experimental group, in the pre test 8 (32%) had poor intake and
17 (68%) had a fair intake of feeding whereas in the post test, 4 had a fair intake
and 21 (84%) had a good intake of feeding. In the control group, in the pre test
10 (40%) had poor intake and 15 (60%) had a fair intake of feeding whereas in
post test, 8 (32%) had poor intake and 17 (68%) had a fair intake of feeding .
Hence the music therapy was found to be effective in improving the feeding
pattern of the premature newborn.
79
In the experimental group, in the pre test 10 (40%) had poor sleep and
15 (60%) had moderate sleep whereas in the post test 5 (20%) had moderate sleep
and 20 (80%) had good sleep. In the control group, in the pre test 9 (36%) had
poor sleep and 16 (64%) had moderate sleep whereas in the post test, 7 (28%) had
poor sleep and 18 (72%) had moderate sleep. Hence the music therapy was found
to be effective in improving the sleeping pattern of the premature newborn
The above findings were consistent with the study done by Deepthimol
(2011) has conducted a study to assess the effectiveness of classical music therapy
on physiological and behavioral parameters among the preterm newborns. It was
reported that, there is an increase in the oxygen concentration (post test – 96 +/- 0.4),
decreased heart rate (post test – 132 +/- 2.4), and decreased crying spells among the
preterm newborns.
Objectives – 3 : To assess the effectiveness of music therapy on the pre and post test
level of physiological parameters, feeding and sleeping pattern among the experimental
group.
In the experimental group, in pretest, the mean HR was 152, SD was 6.3;
the mean RR was 34, SD was 3.4 ; the mean SPO2 was 92, SD was 1.07. In the
post test, the mean HR was 141, SD was 1.07 ; the mean RR was 29, SD was
4.9 ; the mean SPO2 was 95, SD was 1.07. It was inferred that post test mean
scores & SD were significantly reduced. Hence music therapy is effective in
maintaining physiological parameters of premature newborns.
80
In the experimental group, the overall pre test mean feeding score was 7,
SD was 1.3, range was 4 and the overall post test mean feeding score was 15, SD
was 1.6, range was 5. The mean difference was 8. The obtained paired t value
was 20 which was significant at the level of p<0.05. It was inferred that there is
a significant difference in the pre and post test level of feeding pattern among the
premature newborn in the experimental group. Hence the music therapy was
found to be effective in improving the feeding pattern of the premature newborn.
In the experimental group, the overall pre test mean sleeping score was 9,
SD was 2.2, range was 6 and the overall post test mean sleeping score was 16,
SD was 1.9, range was 7. The mean difference was 7. The obtained paired t
value was 12.28 which was significant at the level of p<0.05. It was inferred that
there is a significant difference in the pre and post test level of sleeping pattern
among the premature newborns of the experimental group. Hence the music
therapy was found to be effective in improving the sleeping pattern of the
premature newborn.
The above findings were consistent with the study done by Loewy (2013),
conducted a study to determine the effects of music therapy on vital signs, feeding
and sleeping pattern among 272 premature newborns. The study reported that there
was lower heart rate (p< 0.001), sucking behavior (p=0.03) and the caloric intake
(p=0.01) showed differences , and also there is differences in sleeping pattern
(p<0.001) after the music therapy among the premature newborns. It was concluded
that the use of music therapy can influence the cardiac, respiratory function, it also
improves the sucking pattern and increase prolong periods of quiet-alert states of
the premature newborns.
81
Objectives – 4: To find the association between the post test level of physiological
parameters, feeding and sleeping pattern and their selected demographic variables among
the experimental group.
It was inferred that there was no significant association between
the post test level of feeding with their selected demographic variables such as
gestational weeks, age of premature newborns, birth weight, birth order, cry of the
child at birth, APGAR score, gender, religion, residential area, educational status
of mother and occupational status of the mother of the premature in the
experimental group at p<0.05 level.
The above findings were consistent with the study done by Farhat
(2010), has conducted a study to assess the effect of lullaby music on the
physiologic response and weight gain among 44 premature newborns in Imamreza
hospital, Iran. The study concluded that there is a significant difference in the
physiologic responses and the weight gain of the babies, no significant association
with the selected demographic variables of the study.
It was inferred that there was no significant association between the
post test level of sleeping with their selected demographic variables such as
gestational weeks, age of premature newborns, birth weight, birth order, cry of the
child at birth, APGAR score, gender, religion, residential area, educational status
of mother and occupational status of the mother of the premature in the
experimental group at p<0.05 level.
82
The above findings were consistent with the study done by Arnon
(2006) has conducted a study to assess the effectiveness of live music therapy on
the physiological parameters and behavioral pattern (sleep) among the preterm
newborns. The study concluded that live music therapy had a significant association
in reduced heart rate and a deeper sleep in preterm infants and no significant
association with the selected demographic variables of the study.
IMPLICATION
The findings of the study have the following implications in nursing.
NURSING EDUCATION
Nursing curriculum can be modified with increased emphasis of
alternative therapies.
Students can be encourage to practice these therapies during their
clinical postings under proper guidance.
NURSING PRACTICE
Music therapy plays a very effective non pharmacological and non invasive
intervention in maintaining the physiological parameters and helps in
improving the feeding and sleeping pattern of the preterm infants.
83
Music therapy was effective in achieving stress relaxation for babies in
NICU.
Music therapy aids in increasing the tolerance for stimulation in preterm babies
and also helps to decrease the stress of the parents with preterm infants.
NURSING SERVICE
Nurses working in the NICU should have enough knowledge about the care
and needs of the premature newborns.
Nurses in the NICU can be given information about the use of the non
pharmacological therapies and can be encouraged to implicate these
therapies in action.
NURSING RESEARCH
The study reveals the sound knowledge of the nurses in using various
adjuvant therapies.
The study provides awareness for further studies among the student in this
area.
84
LIMITATIONS
Period of music therapy was only 3 days
Non random method was used to select the premature babies.
RECOMMENDATIONS
1. A similar study can be conducted in a large group of preterm babies
2. A longer period of intervention can be studied for more reliability and
effectiveness.
3. Similar study can be done with preterm infants with respiratory distress.
4. A multi-group study can be done by selecting different types of music such
as live music, recorded music, harp music, Mozart effect and Brahm’s
lullaby to evaluate the effectiveness of the type of music on the preterm
infants.
5. A study can be done using music therapy with combination to other therapy
such as massage therapy.
6. The study can be replicated on larger sample in different setting so that the
findings can be generalized to larger population.
85
CONCLUSION
The findings of the study showed that the post test level of physiological
parameters, feeding and sleeping pattern of the premature newborns were improved.
There was a significant (p<0.05) improvement on the physiological parameters,
feeding and sleeping pattern among the premature newborns after the music
therapy. None of the selected demographic variables revealed that the music
therapy had significant association (P> 0.05). Thus the study revealed that music
therapy was effective to improve the physiological parameters, feeding and sleeping
pattern among the Premature Newborns.
86
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Terri Kyle Essentials of Pediatric Nursing, 2nd edition, Wolters Kluwer publications, New Delhi.
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C. Manivannan Textbook of Pediatric Nursing, 2nd edition, EMMESS publications, Bangalore.
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Marilyn . J Hockenberry Wong’s Essentials of Pediatric Nursing, 7th edition, Elseiver publications, New Delhi.
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Dorothy R. Marlow Text Book of Pediatric Nursing, 6th edition, Elseiver publications, New Delhi
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Polit and Beck Nursing Research , 9th edition, Wolters Kluwer publications, New Delhi.
Polit D.F & Hungler B.P, Nursing Research Principles and Methods, 2nd edition Jaypee Brothers Medical Publications, New Delhi.
Rajeshwari Veeralakshmi, Overview of Nursing Research including Bio Statistics, 1st edition, Jaypee Brothers Medical Publications, New Delhi.
Suresh Sharma K, Nursing Research and Statistics, 1st edition, Elseiver publications, New Delhi.
JOURNALS
Caine . Effect of music on selected stress behavior, weight, caloric intake and
length of hospital stay of premature babies in NICU, Journal of Music Therapy, volume 28, issue 4, December 91, page no 180 – 192.
Standley J.M Therapeutic effects of music and mother’s voice on premature infants , Pediatric Nursing, volume 21, issue 6, November 95, page no 509 – 512, 574.
Standley J.M Pre and perinatal growth and development; Implications of music benefits for premature infants , International Journal of Music Education, volume 31, issue 1, 1998, page no 1 – 13.
Bo. L.K Soothing pain-elicited distress in Chinese neonates , Pediatrics, volume 105, issue 4, April 2000, page no E 49.
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Chou LL Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning, The Journal of Nursing Research, volume 11, issue 3, September 2003, page no 209 – 216.
Cevasco A.M, Effects of the pacifier activated lullaby on weight gain of premature infants, Journal of Music Therapy, volume 42, June 2005, page no 123 – 139.
Arnon et.al Live music is beneficial to preterm infants in the neonatal intensive care unit environment, Birth , volume 33, issue 2, June 2006, page no 131 – 136.
Cassidy J.W Effect of decibel level of music stimuli and gender on head circumference and physiological responses of premature babies in NICU, Journal of Music Therapy, volume 46, issue 3, September 2009, page no 180 – 190.
Suzanna .A. Music therapy in the NICU Interventions and Techniques in current practice and a survey of Experience and Designation Implications 2012, Master’s Thesis paper 93. Western Michigan University.
Lubetzky R. Effect of music by Mozart on energy expenditure in growing preterm infants, Pediatrics, volume 125, issue 1, January 2010, page no E24 – 28.
Farhat A. The effect of listening to lullaby music on physiologic response and weight gain of premature infants , Journal of Neonatal – Perinatal Medicine, volume 3, issue 2, 2010, page no 103 – 107.
Schlez A. Combining kangaroo care and the live harp music therapy in the neonatal intensive care setting, Israel Medical Association Journal, volume 13, issue 6, June 2011, page no 354 – 358.
Selvam Ramachandran and Sudip Dutta, Early developmental care Interventions of preterm and very low birth weight infants, Indian Pediatrics, volume 50, August 15 2013, page no 767- 769.
Haslbeck, Music therapy for premature infants and their parents, Nordic Journal of Music Therapy, volume 21, no 3, page no 203 – 226.
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Allen A. Kimberly, Music therapy in NICU, NIH Public Access, Advance
Neonatal care, October 2013, 13(5), page no 1 – 7.
Chitra Sankar, Developmentally supportive care in the Nursery, Indian Journal of Practical Pediatrics, 2012, 14(4), page no 379 – 384.
Jaya Jasmine, Study to assess the effectiveness of Nesting upon Bio-physiological parameters, Neuro-behavioural activity, Sucking responses among preterm babies, TNNMC, Journal of Pediatric Nursing, volume 1, issue 1, Jan-June 2013.
Pasilic Thilaga, Effect of Tactile Stimulation on selected parameters among preterm babies, TNNMC, Journal of Pediatric Nursing, volume II, issue 2, July-Dec 2014.
Jemimam, A Study to assess the effectiveness of prone position on oxygen saturation among preterm babies ,TNNMC, Journal of Pediatric Nursing, volume III, issue 1, Jan-June 2015.
Saumya John, Effectiveness of Massage Therapy on weight and sleep wake pattern among Preterm infants, TNNMC, Journal of Pediatric Nursing, volume III, issue II, July-Dec 2015.
ARTICLES
Standley J.M., The Effective of non-nutritive sucking on nipple feeding of
premature infants, Pediatric Nursing, volume 36, no 3, May-June 2010.
Rasha Srouji, Non-pharmacological Management in children, International Journal of Pediatrics, Hindawi publishing corporation, 2010, article 474838.
Joanne Loewy, The Effects of Music Therapy on Vital signs, feeding and sleep in Premature Infants, American Academy of Pediatrics, volume 131, no 5, page no 902 – 918.
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Aldrige D., Music Therapy Research and Practice in Medicine, from Out o the silence London: Jessica Kingsley.
Elise D Roth, The Relationship between sensory processing patterns and sleep in infants, Master’s and Doctoral projects, paper 239.
Lomeli H.A., Sleep evaluation scales and questionnaires- a review, Actas Esp Psiquiatr 208, 36(1): 50 – 59.
Ann Phalen, Human milk intake in Preterm infants: Correlation of the Preterm Infant Breastfeeding Behavior Scale (PIBBS) and test weighing, 2011, School of Nursing Faculty papers & presentations, paper – 41.
Nyqvist , Early attainment of breastfeeding competence in very preterm infants, Acta Pediatrica , ISSN 0803-5253, page no 34 – 48.
Camila Mendes da Silva, physiological responses of preterm infants submitted to classical music therapy, Revista Paulista de Pediatrica, volume 31, no1, Paulo Jan- March 2013.
Vital Statistics of TN, SRS office of Registrar General, India.
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NET REFERENCE
http://www.music-research.org/ http://musictherapyworld.net http://babygotosleep.com http://medscape.com http://earticles.com/?music-therapy-for-baby/ www.pubmed.com www.ncbi.nlm.nih.gov http://www.shodhganga.inflibnet.ac.in www.rguhs.ac.in www.texastenstep.org www.Online.library.wiley.com http://www.conservancy.umn.edu/ www.icanteach.co.uk www.lancet.com
92
APPENDIX - 1
LETTER SEEKING PERMISSION TO CONDUCT MAIN STUDY
To,
---------------------,
---------------------,
---------------------.
Respected Sir/Madam,
Greetings from Shivparvathi Mandradiar Institute of Health Sciences, Palayakottai, Thirupur.
Subject: requisition to avail the permission to conduct Project – Regarding.
This is to certify that Ms. F.Abimathy is a bonafied student of Shivparvathi Mandradiar Institute of Health Sciences, Palayakottai, Thirupur pursuing II year M.Sc Nursing under The The Tamilnadu Dr. M.G.R. Medical University Chennai. As a partial fulfillment of the university requirement for the award of Master of Science in Nursing Degree, she needs to conduct a research. And she is interested to conduct the study in your esteemed Hospital. So kindly do the needful and grant her permission to conduct the research study.
Research topic : : “A qausi experimental study to assess the effectiveness of music therapy on the physiological parameters, feeding and sleeping pattern among the premature newborns in selected hospital at Erode.”
The details of the research will be briefed in person by her.
Thanking you.
Yours sincerely,
93
94
APPENDIX - 3
LETTER REQUESTING SUGGESTION FOR ESTABLISHING CONTENT VALIDITY
From,
301417101,
II year M.Sc (N),
Shivparvathi Mandradiar Institute of Health Sciences,
Palayakottai, Tirupur.
To,
-----------------------,
-----------------------,
-----------------------.
Through
The principal,
Shivparvathi Mandradiar Institute of Health Sciences,
Palayakottai, Tirupur.
Respected Sir/ Madam,
Subject: Letter requesting opinion and suggestions from part experts for establishing content validity of tool – Regarding.
I am a II year M.Sc Nursing student in Shivparvathi Mandradiar Institute of Health Sciences. As a partial fulfillment of Master Degree in nursing, I have selected the topic mentioned below for the research project to be submitted to “The Tamilnadu Dr. M.G.R. Medical University Chennai”.
95
Topic : “A qausi experimental study to assess the effectiveness of music therapy on the physiological parameters, feeding and sleeping pattern among the premature newborns in NICU, in selected hospital at Erode.”
I kindly request you to validate the following enclosure and give your expert opinion and suggestion for necessary modification of the tool.
Thanking you.
Place : Yours sincerely,
Date : (F.Abimathy).
301417101
Enclosure: 1. Proposal, 2. self structured questionnaire 3. Tool.
96
APPENDIX - 4
CONTENT VALIDITY CERTIFICATE
I hereby certify that I have validated the tool of 301417101 M.Sc Nursing student who is undertaking : “A qausi experimental study to assess the effectiveness of music therapy on the physiological parameters, feeding and sleeping pattern among the premature newborns in selected hospital at Erode.”
Signature of the Expert :
Name :
Designation :
Date
97
APPENDIX – 5
LIST OF EXPERTS
1. Dr. Arvind kumar M.B.B.S. M.D., Consultant Peadiatrician and Neonatologist, Care – 24 Hospital, Erode.
2. Dr. Vasanth kumar M.D., Consultant Peadiatrician, Care – 24 Hospital, Erode.
3. Ms. Dhanya R, Assisstant Professor, S.P.M.I.H.S., Palayakottai.
4. Ms. Suganthi, Staff Nurse, Primary Health Center, Thirchy.
5. Mrs. Pamila Sam, Assistant professor, S.D.A College of Nursing, Ottapalam, Kerala.
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APPENDIX - 6
INFORMED CONSENT REQUISITION FORM
Dear participants,
I am 301417101 studying 2nd year M.Sc (N) at Shivparvathi Mandradiar Institute of Health Sciences, Palaiyakottai, Tirupur. As a part of fulfillment of the program, I am conducting “A Quasi experimental study to assess the effectiveness of music therapy on the physiological parameters, feeding and sleeping pattern among the premature newborns in NICU, in selected hospital, Erode”. I have prepared a procedure for Music therapy. All the data collected will be kept confidential and be used for my study purpose only. I kindly request to extent your co-operation and willingness to participate in the study by giving your written consent.
Thanking you.
Signature of the Investigator
( 301417101 )
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APPENDIX - 7
INFORMED WRITTEN CONSENT FORM
I understand that I am being asked to participate in a research study conducted by 301417101, M.Sc (N) student of Shivparvathi Mandradiar Institute of Health Sciences.
The research study will evaluate the “Effectiveness of music therapy on the physiological parameters, feeding and sleeping pattern among the premature newborns in NICU, in selected hospital, Erode ”. If I agree to participate in the study, I will be interviewed. The interview may be recorded and will take place in a privacy. No identifying information will be included when the interview is transcribed. I understand that there are no risks with this study.
I realize that the knowledge gained from this study may help either me or other people in the future. I realize that my participation in this study is entirely voluntary, and I may withdraw from the study at any time I wish. If I decide to discontinue my participation in this study, I will continue to be treated in the usual and customary fashion.
I understand that all study data will be kept confidential. However, this information may be used in nursing publication or presentations. If I need to, I can contact 301417101 M.Sc. (N) student of Shivparvathi Mandradiar College of Nursing , Palayakottai, Tirupur at any time during the study. (ph.no: 9789041265).
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The study has been explained to me. I have read and understood this consent form, my entire question has been answered, and I agree to participate. I understand that I will be given a copy of this signed consent form.
Signature of the Participant: Date :
Signature of the Investigator: Date:
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அறிவ ஒ ப த ப வ
சிவபா வதி ம றா யா ெசவலிய க ய சா ப
ெச வ .ப .அபமதி, நிைல இர டா ஆ மாணவ நட இ த
ஆ வ எ ைன ப ேக க ேக ெகா டைத நா ஏ ெகா கிேற .
ஈேரா மாவ ட , ேக 24 ம வமைனய உ ள ப சிள ழ ைத
தவர சிகி ைச ப வ உ ள ைறமாத ழ ைதக இைச பய சி
த வத ல அ ழ ைதய உடலிய அள , தா பா எ
ைற ம கநிைல ேம ப த ெதாட பான ஆரா சி நா
ஒ ெகா கிேற .
இ த ஆ நா ஒ ெகா டா அதைன ெதாட உ ள
ேந க உைரயாடலி ப ேக க ேவ எ பைத நா அறிேவ .
எ னட நட ேந க உைரயாட அைன பதி ெச ய ப
பா கா க ப எ பைத நா அறிேவ .
இ த ஆ வ லமாக என எ ழ ைத எ த பாதி
இ ைல எ பைத நா அறி ெகா ேட எதி கால தி இ த ஆ வ
க என ேகா அ ல ப ற ம க ேகா பய ப எ பைத நா
அறிேவ .
நா எவ /யா ைடய க டாய தி ெபய ேலா அ ல
வ தலி ெபய ேலா இ த ஆ வ ப ெகா ளவ ைல எ பைத ,
ேதைவ ப டா நா ஆ வலி வலகி ெகா ள என
உ ைம உ எ பைத அறிேவ .. அ வா ஆ வலி வலகி
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ெகா ப ச தி எ ேபா ப றைர ேபாலேவ நட த ப ேவ எ பைத
அறிேவ . எ ைன ப றிய அைன
தகவ க இரசியமாக பா கா ப எ பைத அறிேவ . ேதைவ ப
ேபா ஆ வ க ெசவலிய சா த ப தி ைககள ,
க தர கள ெவளயட ச மத அள கிேற .ேதைவ ப
ேபா எ ேபா ேவ மானா ஆ வ ப ெகா ள ச மத
அள கிேற .
இ த ஆ வைன ப றிய ச ேதக கைள ெதள ப தி ெகா ள
சிவபா வதி ம றா யா ெசவலிய க , பைழயேகா ைட நிைல
இர டா ஆ பய மாணவ ெச வ .ப .அபமதிைய எ ேபா
ேவ மானா ெதாட ெகா ளலா எ பைத அறிேவ . (ைகேபசிஎ :
97890 41265)
இ த ஆ வைன ப றிய வள க என
அள க ப கிற . அதைன நா றி மாக ெகா ஆ வ
ப ெகா ள ச மதி கிேற .
ப ெகா பவ ைகெயா ப ேததி :
ஆரா சியாள ைகெயா ப ேததி :
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APPENDIX - 9
INTERVIEW GUIDE ON EFFECTIVENESS OF MUSIC THERAPY AMONG PREMATURE NEWBORNS IN NICU OF SELECTED
HOSPITAL
INSTRUCTION CODE NO:
This section deals with the demographic variables of the respondents. The interviewer will pose questions listed below and place ( ) tick mark against the correct answer.
SECTION – 1
DEMOGRAPHIC VARIABLES
1. Gestational weeks of newborn a. Below 30 weeks b. 31 – 33 weeks c. 34 – 36 weeks
2. Age of premature newborn after birth a. 1 – 7 days b. 8 – 14 days c. 15 – 21 days d. 22 – 28 days
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3. Birth weight a. 2 – 1.751 kg b. 1.750 – 1.501 kg c. 1.500 – 1.251 kg d. > 1.250 kg
4. Birth order of newborn a. One b. Two c. Three
5. Cry of the child at birth
a. Did not cry b. Weak cry c. Cried well
6. APGAR Score after 5 minutes a. 0 – 3 b. 4 – 6 c. 7 – 10
7. Gender a. Male b. Female
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8. Religion a. Hindu b. Muslim c. Christian
9. Residential area a. Urban b. Rural
10. Educational status of the mother a. Primary b. Secondary c. Higher secondary d. Graduate e. Illiterate
11. Occupational status of the mother a. Private employee b. Government employee c. Own business d. At home
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SECTION – 2
Part – 1
Physiological parameters
1. Heart rate a. < 140 b. 141 – 150 c. > 151
2. Respiratory rate a. < 30 b. 31 – 40 c. > 41
3. SPO2 a. 90 – 92 b. 93 – 95 c. 96 – 98
Scoring interpretation:
3 – Normal 2 – Irritable 1 – Restless
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Part – 2
PIBBS scale
1. Rooting of the baby a. Did not root b. Showed some rooting c. Showed simultaneous rooting
2. Areolar grasp by the baby a. None, mouth touched only nipple b. Part of nipple c. Whole nipple, not areola d. Nipple and some areola
3. Latched on by the baby a. Did not latched on b. Latched on for less than 1 minute c. Latched on for 1 – 15 minute d. Latched on for more than 15 minutes
4. Sucking by the baby a. No sucking / licking b. Licking and tasting but not sucking c. Single suck ( 2 – 9 ) d. Repeated short sucking ( > 10 ) e. Repeated long sucking
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5. Longest suck by the baby a. No sucking b. 1 – 4 sucks c. 5 – 9 sucks d. 10 – 14 sucks e. 15 – 19 sucks f. 20 – 25 sucks g. More than 25 sucks
6. Swallowing pattern of the baby a. No swallowing b. Swallowing was noticed c. Repeated occasional swallowing
Scoring interpretation:
0 - 6 : Poor intake 7 - 13 : Fair intake 14 – 20 : Good intake
Part – 3
Modified BISQ
1. Nocturnal sleep duration of the baby a. Less than 6 hrs b. 6 – 8 hrs c. 8 – 10 hrs d. More than 10 hrs
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2. Day time sleep duration of the baby a. Less than 8 hrs b. 8 – 10 hrs c. 10 - 12 hrs d. More than 12 hrs
3. No of night waking of the baby a. More than 8 times b. 6 – 8 times c. 3 – 5 times d. Less than 2 times
4. Duration of night wakefulness of the baby a. 0 – 5 minutes b. 5 – 10 minutes c. 10 – 15 minutes d. More than 15 minutes
5. Sleep onset time duration after wakefulness by the baby a. 0 – 5 minutes b. 5 – 10 minutes c. 10 – 15 minutes d. More than 15 minutes
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6. No of morning wakefulness by the baby a. More than 8 times b. 6 – 8 times c. 3 – 5 times d. Less than 2 times
7. Total duration of sleep by the baby a. Less than 14 hrs b. 14 – 16 hrs c. 16 – 18 hrs d. More than 18 hrs
Scoring interpretation:
0 – 7 : Poor sleep 8 – 14 : Moderate sleep 15 – 21 : Good sleep
Total Score interpretation of the Tool:
Total score - 50
Least score - 0
0 – 16 : Poor improvement
17 – 33 : Fair improvement
34 – 50 : Good improvement
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ய றி வவர
1. ைற ப ரசவ ழ ைதய க வள சி வார க
அ. 30 வார க
ஆ. 31-33 வார க
இ. 34-36 வார க
2. ைற ப ரசவ ழ ைத ப ற த ப ன உ ளவய
அ. 1-7 நா க
ஆ. 8-14 நா க
இ. 15-21 நா க
ஈ. 22-28 நா க
3. ப ற எைட
அ. 2 – 1.751 கிேலா
ஆ. 1-750 – 1.501 கிேலா
இ. 1.500 – 1.251 கிேலா
ஈ. >1.251 கிேலா
4. ப ற வ ைச
அ. ஒ
ஆ. இர
இ.
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5. ழ ைத ப ற தேபா அத அ ைக
அ. அழவ ைல
ஆ. ேசா வான அ ைக
இ. ந றாக அ த
6. APGAR மதி ெப
அ. 0-3
ஆ. 4-6
இ. 7-10
7. பாலின
அ. ஆ
ஆ. ெப
8. மத
அ. இ
ஆ. ல
இ. கிறி தவ
9. வசி பட
அ. நக ற
ஆ. கிராம ற
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10. தாய க வ த தி
அ. த ைம நிைல க வ
ஆ. ந நிைல க வ
இ. உய நிைல க வ
ஈ. ப டதா க
உ. ப காதவ
11. தாய ேவைலவா
அ. தனயா ேவைல
ஆ. அர பண
இ. ெசா தமான ெதாழி
ஈ. வ உ ளா
ப – ஆ
I- உடலிய அள
1. இதய
a. < - 140
b. 141-150
c. 151 அதிகமாக இ த
2. வாகவகித
a. < - 30
b. 31-40
c. 40 அதிகமாக இ த
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3. ஆ ஸிஜ த
a. 90-92
b. 93-95
c. 96-98
மதி ெப வள க
3 - சாதாரணநிைல
2 - அைமதிய றநிைல
1 - எ ச நிைல
II - ைற ப ரசவ ழ ைதய தா பா எ ைற றி த வவர க
1. ழ ைதய தா பா எ அ பைட த னய ெச ைக
a. இ ைல
b. ைம ெபறவ ைல
c. ைமயாக உ ள
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2. ழ ைத, தாய மா ப உ ள க வ ட ப தி ப த
a. இ ைல, ழ ைதய வா ைல கா ைப ம ப றிய த
b. ைலகா ப ஒ ப திைய ம ழ ைத ப றிய த
c. ழ ைத, ைலகா ைப ைமயாக ப த , ஆனா சி
க வ ட ப திைய ப றவ ைல
d. ழ ைத, ைலகா ைப ைமயாக ப த ம சி க வ ட
ப திய ஒ ப தி ம ப றிய த .
3. ழ ைத, தாய மா ப ெபா த இ தலி காலேநர க
a. ழ ைத, ெபா தவ ைல
b. 1 மண ள ைறவாக ெபா த
c. 1-15 மண ள ெபா இ த
d. 15 மண ளக ேமலாக ெபா தி இ த
4. ழ ைதய தா பா உறி த ைமக
a. ழ ைத, உறி சவ ைல
b. ழ ைத ச த ஆனா உறி சவ ைல
c. ஒ ைற ம உறி த
d. ைற த அளவ உறி த (> 10)
e. அதிகமாக ெந ேநர உறி த
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5. ழ ைதய ெந ேநர உறி திற
a. உறி சவ ைல
b. 1-4 ைற உறி த
c. 5-9 ைற உறி த
d. 10-14 ைற உறி த
e. 15-19 ைற உறி த
f. 20-285 ைற உறி த
g. 25 ைற ேமலாக உறி த
6. ழ ைத தா பா உறி சி வ த
a. ழ ைத தா பா வ கவ ைல
b. ழ ைத அ வ ேபா வ கிற
c. ழ ைத ந றாக தா பா வ கிற
ெமா தமதி ெப : 20
மதி ெப வள க
0-6 : ைறவாக தா பா எ கிற
7-13 :மிதமாக தா பா எ கிற
14-20 :ந றாக தா பா எ கிற
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III - ழ ைதய கநிைல றி த வவர க
1. ழ ைதய இர ேநர க
அ. 6 மண ேநர தி ைறவாக
ஆ. 6-8 மண ேநர க
இ. 8-10 மண ேநர க
ஈ. 10 மண ேநர தி அதிகமாக
2. ழ ைதய காைலேநர க
அ. 8 மண ேநர தி ைறவாக
ஆ. 8-10 மண ேநர க
இ. 10-12 மண ேநர க
ஈ. 12 மண ேநர தி அதிகமாக
3. ழ ைத எ வள ைற இரவ வழி கிற ?
அ. 8 ைற அதிகமாக
ஆ. 6-8 ைற
இ. 3-5 ைற
ஈ. < 2 ைற
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4. ழ ைத எ வள ேநர இரவ வழி தி கிற
அ. 0-5 நிமிட க வைர
ஆ. 5-10 நிமிட க வைர
இ. 10-15 நிமிட க வைர
ஈ. 15 நிமிட க அதிகமாக
5. ழ ைத வழி த ப ற க ெச வத எ ெகா கால
அள
அ. 0-5 நிமிட க
ஆ. 5-10 நிமிட க
இ. 10-15 நிமிட க
ஈ. 15 நிமிட க வைர
6. ழ ைத எ வள ைற காைலய வழி கிற
அ. 8 ைற அதிகமாக
ஆ. 6-8 ைறக
இ. 3-5 ைறக
ஈ. < 2 ைற
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7. ழ ைத ெமா த ேநர க (இர + காைல)
அ. 14 மண ேநர தி ைறவாக
ஆ, 14-16 மண ேநர க
இ. 16-18 மண ேநர க
ஈ. 18 மண ேநர தி அதிகமாக
ெமா தமதி ெப : 21
மதி ெப வள க
1-7 ைறவாக க
8-14 மிதமான க
15-21 ந ல க
ப ஆ இ ெமா த மதி ெப : 50
மதி ெப வள க
0-16 : ைறவான ேன ற
17-33 : மிதமான ேன ற
34-50 : ந ல ேன ற
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APPENDIX - 10
PROCEDURE ON MUSIC THERAPY
PREPARATORY PHASE
Select the premature newborn
Set the articles
Music Compact Disk
Head phone
CD drive
PROCEDURE
1. Explain the procedure to the baby’s mother
2. Provide comfortable position for the baby
3. Play the music for 15 minutes
4. Provide the music therapy for 3 consecutive days
AFTER THE PROCEDURE
Baby should be comfortable.